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WHO  IS  INSANE? 


'  ''  I' 


STEPHEN  SMITH 


Columbia  Winibtvs^it^ 
in  t{ie  €itv  of  i^eto  govk 

CoUese  of  l^^viitiansi  anb  ^urgeonst 


3^ef  erence  Hibrarp 


WHO  IS  INSANE? 


WHO 
IS  INSANE? 


BY 

STEPHEN  SMITH,  A.M.,  M.D.,  LL.D. 

COMMISSIONER  IN  LUNACY  OF  THE  STATE  OF  NEW  YOEK 

1882  - 1888 


Mew  Wovli 

THE  MACMILLAN  COMPANY 

1916 

All  Rights  Reserved 


Copyright,  1916 
By  STEPHEN  SMITH 


Set  up  and  electrotyped.    Published  January,  1916 


'0  %  Mtmnr^  tsf 


WHO   IS    INSANE? 


FOREWORD 

IN  the  year  1882  I  was  appointed  the  State 
Commissioner  in  Lunacy  of  New  York  by 
Gov.  Alonzo  B.  Cornell.  On  assuming  the 
duties  of  the  office  the  Governor  informed  me 
there  was  a  popular  and  growing  belief  that 
many  inmates  of  the  Asylums  for  the  Insane 
were  sane  but  have  never  had  an  opportunity 
to  relate  their  grievances  except  to  officers  who 
gave  little  or  no  credence  to  the  patients'  state- 
ments. Therefore,  he  advised  me  to  keep  con- 
stantly in  mind  when  visiting  an  Asylum  the 
question,  "Who  is  Insane?"  In  carrying  out  his 
instructions  I  became  quite  obsessed  with  these 
three  words  and  hence  the  title  of  this  Book. 

The  insane  of  the  State  of  New  York,  in  cus- 
tody, were  at  that  time  about  12,000  in  number 
and  were  confined  in  State  Asylums,  in  County 
Asylums,  in  Poor  Houses  and  in  private  insti- 
tutions. They  were  found  in  every  condition 
hitherto  known  in  the  history  of  this  unfor- 
tunate class  from  that  of  the  pauper  of  the 
County  Alms  House,  in  filthy  cells  and  stalls, 
shackled  hands  and  feet,  and  fed  like  swine, 
to  the  kindly  care,  good  food,  clean,  sanitary 
dormitories  and  freedom  from  cruel  forms  of 
restraint,  of  those  in  the  palatial  State  Asylums. 


8  WHO   IS   mSANE? 

The  most  important  reforms  effected  by  my 
service  were:  1.  The  introduction  of  the 
Training  School  for  Attendants;  2.  The  crea- 
tion of  a  State  Commission  in  Lunacy;  3.  The 
removal  of  the  insane  from  County  to  State 
care.  The  Training  School  raised  the  grade  of 
qualification  of  attendants  and  has  become  a 
permanent  feature  of  State  institutions  for  the 
insane.  The  Commission  in  Lunacy  has  so  re- 
organized the  service  of  the  former  State  Insti- 
tutions for  the  Insane  as  to  change  them  from 
Custodial  "Asylums"  to  Curative  "State  Hos- 
pitals." The  "State  Care  Act"  permanently  re- 
moved the  insane  from  the  beastly  quarters  and 
care  of  the  "Poor-Houses"  to  the  humane  treat- 
ment of  the  State. 

These  three  reforms  have  raised  the  standard 
of  care  and  treatment  of  the  insane  in  the  State 
of  New  York  to  the  highest  grade  yet  attained. 
Nor  is  this  reform  limited  to  the  "State  Hospi- 
tals" of  this  State,  but  fortunately,  their  exam- 
ple is  being  copied  so  widely  as  to  give  the 
assurance  that  the  time  is  not  distant  when  the 
institutions  for  the  insane  in  this  country  will 
take  the  first  rank. 

This  Book  is  a  commentary  on  my  experi- 
ences as  an  official  visitor  of  the  Institutions 
for  the  Insane  and  the  Charities  and  Reforma- 
tories of  the  State.  Its  intent  and  purpose  are 
to  illustrate  with  as  few  technicalities  as  possible 
the  illusive  nature  of  insanity,  its  origin  in  the 


WHO  IS  INSANE  / 


derangement  of  the  functions  of  the  brain-cells, 
the  extreme  impressibility  of  these  cells  and  our 
power  to  increase  or  repress  their  activities.  In 
these  facts,  which  modern  science  has  devel- 
oped, are  found  the  scientific  principles  on 
which  the  prevention  of  insanity,  and  its  suc- 
cessful treatment,  must  be  based.  The  same 
principles  are  shown  to  be  applicable  to  the 
education  of  the  mentally  defective  classes  and 
to  the  reform  of  criminals. 

This  Book  should  prove  helpful  in  the  preven- 
tion of  insanity  at  the  different  periods  of  life 
and  hopeful  of  the  time  when  biology  shall  be 
able  to  completely  unfold  the  mysterious  mech- 
anism of  the  brain,  physiology  to  explain  the 
function  of  every  nerve  centre  and  psychology 
to  interpret  the  significance  of  all  mental  phe- 
nomena. The  Author. 

January,  1916, 


CONTENTS 

PART  ONE 

Who  is  Insane  and  What  is  Insanity? 

Chapter  Page 

I.    Who  is  Insane? 17 

11.     Is  There  Any  Sure  Sign  of  Insanity?    31 

III.  The  Diagnosis  of  Insanity  at  Sight. .     41 

IV.  What  is  Insanity? 59 

y.    How  We  Become  Insane 71 

PART  TWO 

Critical  Periods  of  Life  Predisposing 
TO  Insanity 

VI.    Childhood 95 

VII.    Adolescence   107 

yill.    Mid-Life    119 

IX.    Climacter   127 

X.    Old  Age   137 


CONTENTS— Continued 

Chapter  Page 

XL     The  Prevention  of  Insanity 147 

XII.     The  Susceptibility  of  the  Insane  to 

Curative  Measures   153 

PART  THREE 

Care  and  Treatment  of  the  Insane 

XIII.  Mechanical  Restraint  171 

XIV.  Custodial  Care 177 

XV.     Curative  Treatment    183 

XVI.     Cure  the  Curable    193 

XVII.     Use  the  Usable 199 

XVIII.     Voices  from  the  Asylums 209 

XIX.     State  Care  of  the  Insane 219 


CONTENTS— Continued 

PART  FOUR 

The  Lesson  Applied  to  the  Feeble-Minded 
AND  Criminal 

Chapter  Page 

XX.    Extend  Curative  Methods  to  all  the 

Dependent  Classes   233 

XXL     Teach  the  Idiot  and  Feeble-Minded 

Self-Care  and  Self-Support 239 

XXIL    The  Treatment  of  the  Criminal. ...  249 

PART  FIVE 

A  New  Institution — The  Dawn  of  a 
Better  Day 

XXIIL     A  New  Institution 271 

XXIV.    Eugenics   283 


PART  ONE 
Who  Is  Insane  and  What  Is  Insanity? 


I 

Who  Is  Insane? 


Who  Is  Insane? 


HO  is  insane?  No  one,  or  every 
one,  according  to  the  persons 
questioned.  No  one  in  an  asy- 
lum will  admit  that  he  or  she  is 
insane.  Each  in  turn  would  re- 
sent such  an  insinuation.  Cer- 
tainly no  one  out  of  an  asylum 
will  assent  to  the  charge  of  being  insane.  And 
yet  the  sane  and  insane  readily  rec- 
No  One  or  ognize  the  insanity  of  others.  An 
Every  One  intelligent  old  lady,  once  the  head 
of  a  Ladies'  Seminary,  wished  to  be 
discharged  from  an  asylum  alleging  that  all  the 
patients  in  the  Hall  believed  her  sane. 
Seven  women  were  privately  asked  their 
opinion  as  to  her  sanity,  and  all  declared 
she  was  very  insane,  while  asserting  their  own 
sanity.  When  informed  of  the  result  of  the  test, 
the  old  lady  accurately  described  the  special  pe- 
culiarities of  each  of  her  accusers,  but  could  not 
realize  her  own  condition. 

So  it  is  in  every  community.    The  private  gos- 

17 


18  WHO  IS  INSANE? 


sip  is  much  concerned  about  those  who  are 
called  "strange,"  "peculiar,"  "deranged,"  "un- 
balanced," "light-headed,"  "a-little-off,"  "out-of 
gear,"  "wrong-in-the-upper-story,"  "cranks." 
Few,  if  any,  escape  for  a  life-time  one  or  the 
other  of  these  epithets.  Without,  as  within  the 
asylum,  no  one  recognizes  his  or  her  own  mental 
deviations,  but  readily  detects  the  aberrations  of 
others.  It  is  an  apt  illustration  of  the  old  pre- 
cept, "Let  me  pull  out  the  mote  out  of  thine  eye, 
— and,  behold,  a  beam  is  in  thine  own  eye." 

N  the  world  at  large,  every  advanced  thinker, 

enthusiastic  reformer  and  popular  teacher  is 

almost  certain  to  be  classed  with  the  insane. 

The  friends  of  the  Master  said:     "He  is  beside 

himself";  St.  Paul  was  declared  "mad"  by  the 

highest  judicial  tribunal; 
Advanced  Thinkers  Luther  was  charged  with 
Classed  as  Insane       hallucinations;    Napoleon 

had  his  guiding  star;  Byron 
was  "erratic";  Wilberforce  and  Garrison  were 
"fanatics."  "Genius  is  a  neurosis,"  says  a  French 
authority,  and  Dryden  wrote,  "Great  wits  are 
sure  to  madness  near  allied." 

"The  popular  judgment  of  the  insane  is  largely 
based  on  unjust  prejudices,"  said  an  eminent 
alienist.  It  is  true,  whatever  may  be  the  expla- 
nation, that  we  have  an  instinctive  dread  of  the 
insane,  and  shrink  from  contact  or  association 


WHO  IS  INSANE?  19 


with  them.  The  sudden  discovery  that  our  com- 
panion, with  whom  we  may  have  had  an  agreea- 
ble and  profitable  conversation,  has  an  illusion, 
delusion  or  hallucination,  however  harmless, 
gives  us  at  once  an  undefinable  sense  of  discom- 
fort, or,  perhaps,  of  insecurity.  We  wish  to  es- 
cape his  presence.  His  sane  and  sensible  opinions 
on  all  current  topics  weigh  nothing  in  our  esti- 
mation. Failing  in  one  particular  mental  func- 
tion, we  cannot  believe  that  his  judgment  is  re- 
liable on  any  subject. 


WHILE  this  feeling  on  our  part  is  appar- 
ently instinctive  because  so  universal, 
yet  with  many  it  has  been  intensified  in  child- 
hood by  that  terror  of  the  neighborhood,  a 
crazy  man  or  woman,  whom  the  friends  per- 
sist in  retaining  at  home,  confined  in  a  garret 

or  other  out-of-the-way 
Popular  Pre  judice  place.  "Run,  boys,  old  Je- 
Against  the  Insane    rusha  is  coming,"  was  the 

frequent  signal  of  alarm  in 
our  boyhood  days  when  one  of  our  number  saw 
the  truly  frightful  figure  of  a  woman,  roaming 
in  the  fields,  her  outer  dress  thrown  over  her 
head,  and  a  butcher's  knife  thrust  under  a  belt 
about  her  waist.  She  proved  to  be  a  "terror  by 
night"  to  all  of  the  children  of  that  vicinity  dur- 
ing their  lives,  for  she  appeared  ever  after  in 
all  of  their  disturbed  dreams. 


20  WHO  IS  INSANE? 


Many  have  their  fear  and  dread  of  the  in- 
sane intensified  by  the  occasional  horrible 
crimes  which  they  commit.  Without  reason 
we  are  disposed  to  accept  the  one  act  of  a  sin- 
gle person  as  characteristic  of  the  reliability 
of  ten  thousand  of  that  class. 

When,  however,  we  are  brought  into  more 
familiar  contact  with  the  insane,  and  become 
interested  in  their  special  peculiarities  of 
thought  and  action,  a  strange  fascination  may 
take  the  place  of  fear,  giving  rise  to  an  intense 
desire  to  analyze  and  interpret  their  mental  op- 
erations. Even  "Old  Jerusha"  ceased  to  be  a 
terror  when  we  became  more  familiar  with  her 
history. 

Personally,  I  came  to  be  greatly  interested 
in  her  visits  to  our  home,  though  these  visits 
were  often  made  at  midnight.  She  was  very 
fond  of  my  mother,  and  her  tap  on  the  door 
with  the  handle  of  her  knife  awakened  me  to  a 
sense  of  security,  rather  than  fear.  Mother  al- 
ways cheerfully  responded  to  her  knock,  in- 
vited her  to  come  in,  prepared  a  cup  of  tea,  and, 
together,  they  discussed  current  neighborhood 
events.  It  was  only  when  the  course  of  their 
conversation  brought  to  her  thoughts  her  be- 
trayer that  Jerusha  showed  any  considerable 
mental  disturbance.  At  the  thought  of  him, 
she  would  seize  her  knife,  and,  brandishing  it 
over  her  head,  excitedly  exclaim:     "If  I  ever 


WHO  IS  INSANE?  21 


meet  him  I'll  bathe  this  blade  in  his  heart's 
blood!"  A  touch  of  my  mother's  finger  upon 
her  arm,  and  a  deprecating  glance  at  the  bed- 
room of  the  children,  brought  a  humble  apol- 
ogy and  an  immediate  return  of  the  knife  to  her 
belt. 

WHEN,  instead  of  observing  the  life  of  a  sin- 
gle insane  person,  our  duties  lead  us  to 
study  them  isolated  in  a  community,  as 
they  are  found  in  asylums,  a  new  and  altogether 
different  impression  is  made  upon 
The  Insane     us,  which  not  only  supplants   all 
in  Asylums    fear  or  dread  of  contact  with  them, 
but  gives  every  phase  of  their  lives 
an  interest  of  marvelous  intensity.    We  seem  to 
be  among  a  people  so  like  ourselves  in  many  re- 
spects, and  so  unlike  in  others,  that  at  first  we 
experience  a  degree  of  mental  confusion  quite 
disturbing. 

If  the  visitor  to  an  asylum  is  an  official,  who 
is  required  to  converse  with  every  one  who  de- 
sires to  speak  with  him,  apart  from  officers  and 
attendants,  the  impression  that  is  made  upon 
his  mind  becomes  so  pronounced  that  he  can- 
not possibly  escape  the  conviction  that  there  can 
be  no  hard  and  fast  lines  drawn  between  large 
numbers  of  the  sane  and  insane.  He  discovers 
that  he  is  in  a  community  of  people  quite  as  full 
of  mental  activities  as  the  one  he  left  in  the  out- 


22  WHO  IS  INSANE? 


side  world.  Here  he  finds  the  same  passions, 
emotions,  conceptions  and  themes  of  conversa- 
tion that  occupy  the  people  of  the  town.  One 
is  loitering  along  the  hall  like  a  man  of  leisure, 
another  walks  rapidly  with  knitted  brow  as  if 
intent  on  business,  a  third  is  reserved  or  even 
morose,  as  if  laboring  under  a  disappointment, 
a  fourth  is  talkative  and  mirthful,  and  laughs 
at  every  unusual  event.  Evidently  each  one 
has  a  special  subject  of  interest  to  him  or  her 
alone,  which  occupies  the  thoughts  to  the  ex- 
clusion of  everything  else.  On  this  one  topic  the 
individual  speaks  freely  and  earnestly,  and, 
whether  correctly  or  incorrectly,  certainly  with 
entire  candor. 

My  impression  of  the  insane  in  asylums  was, 
therefore,  that  they  form  a  community  not  very 
unlike  the  ordinary  village.  There  are  in  each 
the  quiet,  sober,  thoughtful;  the  active,  restless, 
excitable;  the  queer,  peculiar,  nondescript. 

THE  mental  impression  which  a  stranger  to 
the  insane  experiences,  after  a  day  spent  in 
constant  conversation  with  the  inmates  of  an 
asylum  as  he  meets  them  under  varying  condi- 
tions, is  peculiarly  confusing.    For  my  own  part 

I  could  not  divest  myself  of 

Every  One  the    impulse    to    regard    and 

Seemed  Insane      treat  every  one  whom  I  met 

in    the   outside  world   as   in- 
sane.   Whether  walking  along  the  public  street. 


WHO  IS  INSANE?  23 


or  entering  a  passing  car,  or  stopping  at  a  hotel, 
I  could  not  escape  the  conviction  that  I  was  still 
among  the  insane.  Involuntarily,  I  endeavored 
to  determine  from  what  form  of  insanity  every- 
one with  whom  I  conversed  was  suffering. 

The  more  rational  they  appeared  to  be,  the 
more  closely  I  questioned  them,  in  the  constant 
expectation  of  discovering  the  carefully  con- 
cealed clue  to  their  mental  delinquencies.  As 
never  before,  though  quite  unconsciously  at 
the  moment,  I  studied  the  peculiarities  of  each 
stranger  and  strove  to  detect  in  his  or  her  feat- 
ures, dress,  manner  or  acts,  the  latent  evidences 
of  an  unsound  mind.  And  it  is  true,  I  met 
many  persons  in  the  outside  world,  active  in  its 
affairs,  who,  on  careful  scrutiny,  exhibited 
mental  aberrations  quite  as  distinct  as  did  many 
of  the  inmates  of  the  asylum.  Especially  was 
this  true  of  perversions  of  the  senses,  as  of  see- 
ing, hearing,  smelling,  tasting,  touching.  While 
in  large  numbers  of  cases  the  evidences  of  men- 
tal disturbance  were  readily  recognized,  in  other 
cases  the  most  careful  and  painstaking  inquiry 
elicited  no  positive  proof  of  a  deranged  mind. 


BUT  though  I  had  become  so  inquisitive  as  to 
the  insanity  of  others,  I  was  altogether  un- 
prepared for  the  discovery  that  I  was  about 
to  have  my  own  sanity  tested  by  an  inmate  of  an 


24  WHO  IS  INSANE? 


asylum.     "Who  is  insane,  you  or  I?"  was  the 

startHng  question  put  to   me 
Who  Is  Insane,      as   I  walked  along  the  Hall, 
You  or  I?  pencil  and  paper  in  hand.     I 

was  intently  studying  the  pe- 
culiarities of  others  to  determine  the  special 
features  of  their  mental  aberrations,  but 
it  had  not  occurred  to  me  that,  from  the  view- 
point of  the  inmates  of  an  asylum,  I  might  my- 
self be  a  "suspect."  I  was  not  surprised  at  the 
first  part  of  the  question,  "Who  is  Insane?"  for 
that  was  constantly  uppermost  in  my  own  mind. 
It  was  the  entirely  unexpected  application  of  the 
inquiry  to  myself  that  created  momentary  men- 
tal confusion. 

My  querist  was  a  young  lady  who  had  been 
a  prominent  teacher  in  a  seminary  for  young 
ladies.  Her  mobile  features,  quick  movements, 
excited  manner  and  rapid  speech  indicated  a 
highly  organized  nervous  system.  The  mincing 
manner  of  her  approach,  the  sarcastic  smile  and 
the  attitude  of  expectancy  which  she  assumed, 
her  head  being  poised  on  the  tip  of  her  finger 
resting  on  her  cheek,  showed  that  she  antici- 
pated the  embarrassment  which  her  question 
might  create.  Other  patients,  who  heard  the 
question,  quickly  gathered  about  us,  all  evi- 
dently intent  on  hearing  my  answer. 

At  a  loss  for  an  explanation  which  would  not 
offend  so  sensitive  an  audience,  I  hesitated  a 


WHO  IS  INSANE?  25 


moment,  and  then  replied:  "Why  you,  of 
course,  are  insane."  She  slowly  and  thought- 
fully repeated  my  words,  and  added  in  the  same 
strain,  "You,  of  course!  Why,  *of  course?'  Do 
you  see  insanity  in  my  features?"  Taking  a 
small  mirror  from  a  stand,  she  moved  it  before 
her  face,  saying:  "Will  you  be  so  kind  as  to 
teach  me  how  to  examine  a  person's  face  and 
discover  what  may  be  his  mental  condition?" 
She  placed  herself  in  different  attitudes,  hold- 
ing the  mirror  in  different  positions,  and  mak- 
ing ludricous  grimances,  greatly  to  the  amuse- 
ment of  the  by-standers.  She  continued:  "If 
you  will  teach  me  your  occult  art,  I  should  be 
delighted  to  be  able  to  say  to  anyone  I  meet: 
'Why,  of  course,  you  are  insane.'  If  I  become  as 
expert  as  you  think  you  are,  and  had  your  assur- 
ance, I  might  even  say  to  you,  'Why,  you,  of 
course,  are  insane.' " 

The  interview  was  becoming  decidedly  per- 
sonal, and  the  patients  gathered  around  us 
were  excited  by  the  shrewd  turn  of  her  remarks, 
and  boisterously  applauded  the  points  which 
she  made  against  me.  I  attempted  to  bring  the 
colloquy  to  a  close,  but  she  spoke  so  rapidly  that 
I  could  not  interrupt  her,  until  I  turned  away, 
when  she  apologized  for  what  she  said  I  might 
regard  as  rudeness,  but  which  she  felt  was  the 
proper  improvement  of  a  rare  opportunity  to 
express  her  opinions. 


26  WHO  IS  INSANE? 


"You  altogether  mistook  the  meaning  of  my 
reply  to  your  question,"  I  said,  with  as  much 
composure  as  I  could  command.  "I  did  not  and 
could  not  decide  as  to  your  sanity  or 
insanity  by  any  peculiarity  of  your  feat- 
ures, nor  for  anything  noticeable  in  your 
personal  appearance,  for,  in  these  re- 
spects, I  see  no  difference  between  you 
and  many  whom  I  meet  in  the  streets.  It  oc- 
curred to  me,  at  the  moment,  that  I  should  make 
no  mistake  in  my  answer  if  I  said  'You,  of 
course,  are  insane,'  for  this  reason,  the  law  pro- 
vides that  only  insane  persons  shall  be  confined 
in  asylums  for  the  insane,  while  the  sane  are 
rigidly  excluded.  Now,  as  between  you  and 
me,  you  are  legally  confined  in  this  asylum,  and 
I  am  legally  excluded;  therefore,  when  you 
called  upon  me  for  a  decision  as  to  'Who  is  in- 
sane, you  or  I,'  I  could  promptly  and  truthfully 
say,  'Why  you,  of  course,  are  insane.' " 

"Ah,  I  see  how  you  work  the  problem,"  she 
said.  "In  an  asylum,  insane;  out  of  an  asylum, 
sane;  it's  the  same  old  story  of  the  ins  and  outs, 
with  this  difference,  that  the  ins  are  anxious  to 
get  out  and  the  outs  are  anxious  not  to  get  in." 

Assuming  a  defiant  attitude,  she  sneeringly 
said:  "This  whole  business  of  locking  people 
in  these  prisons  for  life,  because  some  fool  of  a 
doctor  says  they  are  insane,  is  a  contemptible 
and  transparent  fraud.    You  admit  that  if  you 


WHO  IS  INSANE?  27 


had  met  me  in  the  street,  or  in  the  cars,  or  in  a 
hotel,  you  would  have  declared  me  sane,  but 
happening  to  meet  me  in  this  asylum  you 
promptly  and  audaciously  pronounce  me  in- 
sane. On  what  a  slender  thread  hangs  our  des- 
tiny!" 

With  a  graceful  wave  of  her  hand  and  a  low 
bow  she  withdrew  to  her  room,  leaving  me  to 
my  reflections. 

She  had  propounded  one  of  the  most  pro- 
found questions  known  to  science  and  had  made 
a  declaration  of  immense  social  significance. 
"Who  is  insane,  you  or  I?"  is  a  question  which 
confronts  us  whenever  we  look  into  the  eyes  of 
our  fellows.  And,  truly,  on  what  a  slender 
thread  hangs  our  destiny,  when  we  may  be  com- 
mitted to  an  asylum  for  a  lifetime  because  we 
differ  in  thought,  word  or  action  from  another, 
whose  mental  integrity  has  never  been  gauged 
by  any  absolutely  correct  standard ! 


II. 

Is  There  Any  Sure  Sign  of  Insanity? 


II 

Is  There  Any  Sure  Sign  of  Insanity? 

STUDENT  of  the  famous  alien- 
ist, Esquirol,  inquired  of  him, 
"Is  there  any  sure  sign  by  which 
the     insane     can     be      distin- 
guished?"   He  replied,  "Please 
dine  with  me  to-morrow  at  six 
o'clock."  The  student  complied. 
Two  other  guests  were  present,  one  of  whom 
was  elegantly  dressed  and  apparently  highly  ed- 
ucated,   while    the    other 
Apparent  Insanity      was  rather  uncouth,  noisy 
of  Balzac  and   extremely   conceited. 

After  dinner  the  pupil  rose 
to  take  leave,  and  as  he  shook  hands  with  his 
teacher  he  remarked:  "The  problem  is  very 
simple  after  all;  the  quiet,  well  dressed  gentle- 
man is  certainly  distinguished  in  some  line, 
but  the  other  is  as  certainly  a  lunatic  and 
ought  at  once  to  be  locked  up."  "You  are 
wrong,  my  friend,"  replied  Esquirol  with  a 
smile.  "That  quiet,  well  dressed  man  who 
talks  so  rationally  has  for  years  labored  under 

31 


32  WHO  IS  INSANE? 


the  delusion  that  he  is  God,  the  Father;  where- 
as the  otlier  man,  whose  exuberance  and  self- 
conceit  have  surprised  you,  is  M.  Honore  de  Bal- 
zac, the  greatest  French  writer  of  the  day." 

A  MORE  remarkable  misadventure,  recorded 
on  the  authority  of  the  distinguished 
writer,  Aurelien  Scholl,  befell  not  a  student 
but  a  shining  light  of  medical  science,  Le- 
grand  du  Saule,  one  of  the  acknowledged  au- 
thorities on  mental  diseases  in 
The  Case  of     Paris.    A  well-known  man  of  let- 

Renan  ters,     feeling     uneasy     about     a 

daughter  who  showed  some  signs 
of  eccentricity,  was  anxious  to  get  the 
opinion  of  this  specialist  without  arousing 
her  suspicions.  For  this  purpose  he  concluded 
to  give  a  dinner  to  which  de  Saule  and  several 
other  celebrities  were  invited.  It  was  a  feast  of 
reason  and  the  flow  of  soul  was  full  and  free. 
Legrand  du  Saule  took  little  part  in  the  conver- 
sation, but  listened  attentively  and  used  his 
highly  trained  powers  of  observation. 

Toward  the  end  of  the  dinner  he  leaned  to- 
ward his  host  and  whispered :  "You  may  make 
your  mind  easy  about  your  daughter.  She  is 
suffering  from  nothing  more  serious  than  a  tri- 
fling nervousness  which  will  pass  off.  But  I 
think  it  right  to  tell  you  that  there  is  one  of  your 
guests    whose    mental    condition    is    distinctly 


WHO  IS  INSANE?  33 


alarming,  and,  I  fear,  hopeless."  Being  asked 
who  this  was,  the  oracle  said :  "That  stout  gen- 
tleman yonder,  with  the  look  of  a  canon,  who  is 
laughing  so  heartily."  The  man  who  was  thus 
enjoying  himself,  all  unconscious  of  the  doom 
pronounced  upon  him,  was  Ernest  Renan. 

LORD  Erskine,  who  as  Lord  High  Chancellor 
of  England,  had  supervision  of  the  insane, 
received  several  letters  from  an  inmate  of 
an  asylum,  alleging  false  commitment.  The  let- 
ters were  so  well  written  that  the  Chancellor 
requested  the  superintendent  of 
Insane  on  the  asylum  to  bring  this  patient 
One  Subject  to  him  for  his  personal  exami- 
nation. The  patient  proved  to 
be  a  very  gentlemanly  person,  and  in  conversa- 
tion on  a  great  variety  of  subjects  showed  unu- 
sual intelligence.  Turning  to  the  superintend- 
ent, the  Chancellor  expressed  his  surprise  at  the 
detention  of  a  gentleman  whose  mind  was  so 
well  balanced  and  so  free  from  delusions.  The 
superintendent  requested  the  Chancellor  to  ask 
his  visitor,  "Who  is  the  King  of  England?"  On 
putting  this  question,  the  conduct  and  attitude 
of  the  man  suddenly  changed,  and,  rising  and 
assuming  a  proud  air,  he  placed  his  hand  over 
his  heart,  saying:  "I  am  the  King  of  England, 
and  you  are  my  Lord  Chancellor." 

I  conversed  with  a  man  who  spoke  readily 


34  WHO  IS  INSANE? 


and  very  intelligently  on  a  variety  of  subjects. 
I  could  detect  no  defect  in  his  views  on  what- 
ever topic  we  discussed.  Noticing  that  in  the 
intervals  of  our  conversation  he  looked  at  a 
tree-top  and  smiled,  I  asked  him  if  he  saw  any- 
thing in  the  tree.  "Why,  certainly,"  he  replied, 
"don't  you  see  the  two  women  in  the  tree,  one 
above  the  other,  and  both  smiling  at  us?"  I 
confessed  my  inability  to  see  them,  though  at 
his  suggestion  I  took  different  positions.  He 
ceased  to  converse,  but  in  sotto  voce  declared 
"everybody  is  in  the  conspiracy." 

A  SUPERINTENDENT  requested  me  to  ex- 
amine a  certain  patient  and  inform  him 
as  to  the  man's  sanity.  I  spent  an  hour  or 
more  in  conversation  with  him  and  we  discussed 
a  great  variety  of  subjects.  He  was  very  intelli- 
gent, humorous  and  inquisitive. 
The  Effect  and  I  could  discover  no  sign  of 
of  a  Word  mental  confusion  or  disturbance. 
On  reporting  the  fact  to  the  super- 
intendent he  suggested  that  while  conversing 
with  him  I  should  incidentally  say,  "Telephone." 
On  the  following  day,  while  passing  through  the 
hall  in  which  this  patient  was  confined,  he  came 
to  me  and  we  again  entered  into  conversation, 
the  topic  which  most  interested  him  being  cur- 
rent political  events.  In  an  interval  I  spoke  the 
word,  "Telephone,"  at  which  he  became  excited 


WHO  IS  INSANE?  35 


and  declared  that  I  was  one  of  the  conspirators. 
On  inquiry  I  learned  that  he  never  showed  any 
signs  of  mental  disturbance  except  when  that 
word  was  spoken  in  his  hearing.  He  had  been 
employed  in  an  establishment  in  the  constant 
use  of  a  telephone,  then  a  new  and  novel  instru- 
ment. 

On  visiting  a  county  asylum  one  hot  summer 
day,  I  found  a  very  efficient  man  in  charge. 
The  patients  were  all  in  the  field  and  he  was 
alone.  The  little  isolated  asylum  building  for 
the  insane  was  in  excellent  condition  in  every 
part  and  I  spent  some  time  with  the  attendant 
conversing  on  matters  relating  to  inmates  and 
the  management  of  the  almshouse,  about  which 
he  was  very  well  informed. 

On  finishing  my  inspection  he  invited  me  to 
his  room,  and  on  entering  he  locked  the  door 
and  put  the  key  in  his  pocket.  To  my  inquiry 
as  to  his  training  for  his  present  position,  which 
he  seemed  to  fill  so  acceptably,  he  replied,  with 
marked  emphasis,  that  God  was  his  only  in- 
structor; that  he  was  in  immediate  communi- 
cation with  Him  and  never  took  any  advice 
from  man  or  woman,  but  always  followed  His 
instructions.  I  asked  if  God  should  instruct 
him  to  punish  one  of  the  inmates  would  he  do 
so  without  consulting  the  superintendent.  "Cer- 
tainly," he  replied,  and  raising  the  cover  of  his 
desk  he  showed  me  a  whip,  a  sharp  pointed 
knife  and  a  pistol. 


36  WHO  IS  INSANE? 


Looking  at  my  watch,  I  arose,  expressed  my 
surprise  that  it  was  so  near  train-time  and 
mioved  towards  the  door,  complimenting  him 
meantime  effusively  on  his  devotion  to  his  du- 
ties and  his  reliance  on  God.  I  was  immensely 
relieved  when  he  took  the  key  from  his  pocket, 
opened  the  door  and  gave  me  free  access  to  the 
outer  world.  For  years  this  man  continued  to 
do  excellent  work  as  an  attendant,  and  it  was 
only  when  allusion  was  made  to  this  one  mat- 
ter of  his  source  of  instruction  that  he  showed 
any  symptom  of  insanity. 

THE  preceding  illustrations   seem  to   prove 
that  there  is  no  sure  sign  by  which  the  in- 
sane can  readily  be  detected.     While  the 
grosser  forms  of  insanity  are  easily  diagnosed, 
there  are  vast  numbers  of  cases  that  require  the 
most  careful  and  prolonged  ob- 
No  Sure  Sign    servation  to   determine  the  spe- 
of  Insanity      cial  phase  of  aberration.  In  some 
cases  only  allusion  to  a  certain 
thing,  subject,  or  person  will  cause  the  insane 
to  reveal  their  illusions,  delusions,  or  hallucina- 
tions. 

The  explanation  of  the  apparent  anomaly, 
that  there  is  no  sure  sign  of  insanity,  is  found  in 
the  following  facts : — The  brain  being  a  compli- 
cated mechanism,  as  will  be  shown  in  a  subse- 
quent  chapter,   any   one    of   the   innumerable 


WHO  IS  mSANE?  37 


parts  may  become  deranged  in  its  action.  The 
effect  of  such  derangement  may  be  Hmited  to 
a  change  in  the  function  of  that  part  chiefly,  or 
it  may  involve  a  change  in  the  action  of  many 
parts  closely  allied  in  physiological  activities. 

It  follows,  as  in  any  mechanism,  that  the  evi- 
dences of  mental  derangement  will  be  more  or 
less  obscure  or  pronounced  according  to  the 
functional  relations  of  the  part  in  which  the  dis- 
turbance began.  We  may  derange  the  striking 
apparatus  of  a  clock  without  affecting  it  as  a 
correct  time-piece;  but  if  we  change  the  action 
of  the  pendulum,  we  can  no  longer  rely  upon  the 
clock  as  a  measurer  of  time.  So,  in  the  action 
of  the  brain  (though  in  a  much  larger  sense  own- 
ing to  the  enormous  number  and  intricate  con- 
nection of  its  parts),  the  speaking  of  a  certain 
word  may  be  the  only  method  of  eliciting  the 
derangement.  The  entire  mental  operations 
may  be  deranged  by  the  entrance  of  a  poison 
into  the  blood,  which  would  affect  large  sec- 
tions of  the  brain. 


Ill 

The  Diagnosis  of  Insanity  at  Sight 


Ill 

The  Diagnosis  of  Insanity  at  Sight 

REMARKABLE  exception  to  the 
preceding  proofs  of  the  diffi- 
culty of   diagnosis  of  insanity 
occurred  in  my  personal  expe- 
rience and  is  worthy  of  record 
in  this  connection.    That  an  in- 
sane person  may  be  recognized 
at  sight  by  an  expert  was  demonstrated  in  the 
famous  trial  of  William  Freeman,  the  murderer. 
I  happened  to  be  a  witness  of  the 
A  Dramatic  incident,    which    was    highly    dra- 
Episode    matic  in  all  of  its  details.     In  an 
instant    and    without    warning  the 
large  gathering  of  excited  spectators,  all  intent 
on  the  question  at  issue,  the  insanity  of  the  pris- 
oner, found  the  issue  shifted  to  itself  by  the  de- 
mand of  the  prosecution  that  the  learned  expert 
witness  on  the  stand  should  point  out  an  insane 
person  in  the  audience.     The  trial  was  at  Au- 
burn, New  York,  and  it  happened  that  I  at- 
tended the  court  at  that  critical  period. 

"What !    Do  you  affirm  that  you  can  diagnose 
insanity  at  sight?" 

41 


42  WHO  IS  INSANE? 

"I  do,"  was  the  calm,  dignified,  but  emphatic 
response. 

THIS  question  was  put  by  John  Van  Buren, 
Esq.,  at  that  time  Attorney-General  of  the 

State  of  New  York,  and  was  answered  by 

Dr.  Amariah  Brigham,   Superintendent  of  the 

Utica  Asylum  for  the  Insane.    The  incident  was 

remarkable  for  the  intense  pop- 

The  Freeman     ular  interest  in  the  results  of  the 

Case  trial,  the  scientific  questions  in- 

volved, and  the  eminence  of  the 
now  historical  personages  engaged  in  its  man- 
agement. This  occasion  was  the  trial  of  Wil- 
liam Freeman,  a  negro,  for  the  murder  of  the 
Van  Ness  family  in  the  vicinity  of  Auburn,  Cay- 
uga county.  New  York,  on  the  night  of  the  12th 
of  March,  1846.  The  frightful  tragedy  was  thus 
described  in  a  local  paper: 

"William  Freeman,  a  negro,  a  native  of  Au- 
burn, who  has  recently  been  discharged  after 
five  years'  confinement  in  the  States  Prison, 
having  provided  himself  with  weapons,  proceed- 
ed to  the  house  of  John  G.  Van  Ness,  in  the  sub- 
urbs of  Auburn,  and  there,  without  notice  and 
without  any  apparent  motive,  slew  Mr.  Van 
Ness,  a  wealthy  and  worthy  citizen,  Mrs.  Van 
Ness,  her  sleeping  infant,  and  her  aged  mother, 
and  wounded  mortally,  it  is  believed,  the  labor- 
ing man  who  dwelt  with  them,  leaving  only  the 


WHO  IS  INSANE?  43 


maid  servant  of  the  family,  and  she  had  only 
been  spared  because  he  had  been  disabled  in 
the  affray." 

The  murderer  was  arrested  and  confessed  the 
perpetration  of  the  crime,  but  showed  no  signs 
of  regret;  on  the  contrary,  he  freely  described 
the  incidents  of  the  murder,  and  laughed  con- 
tinually during  the  recital.  The  incensed  and 
excited  public  saw  in  his  strange  acts  and  unac- 
countable conduct,  together  with  the  entire  ab- 
sence of  motive  for  the  crime,  grounds  for  the 
belief  that  he  might  escape  punishment  on  the 
plea  of  some  wily  lawyer  that  the  prisoner  was 
insane.  Crowds  of  excited  people  gathered 
about  the  jail  determined  to  seize  the  prisoner 
and  lynch  him,  but  the  sheriff  adopted  such 
precautions  that  no  serious  effort  was  made  at 
a  rescue.  But  popular  feeling  now  took  another 
form.  It  was  determined  to  resist  to  the  last 
any  effort  that  might  be  made  to  secure  the  es- 
cape of  the  criminal  under  cover  of  alleged  in- 
sanity. The  greatest  vigilance  was  maintained 
over  every  movement  in  the  legal  proceedings 
in  order  to  prevent  that  issue.  What  made  the 
apprehension  that  this  question  would  be  raised 
more  decisive  was  the  circumstance  that  only  a 
month  previously  a  murderer  had  escaped  the 
lawful  punishment  of  his  crime  through  the 
plea  of  insanity  interposed  by  his  counsel,  Wil- 
liam H,  Seward,  Esq.     Tljere  was,  indeed,  a 


44  WHO  IS  INSANE? 


wide-spread  belief  that  the  criminal  in  the  Van 
Ness  tragedy  was  emboldened  to  perpetrate 
murder  owing  to  the  results  of  the  recent  trial. 
The  excitement  of  the  public  was  in  some  meas- 
ure allayed  by  the  remark  of  a  prominent  Judge 
that  the  prisoner  would  not  escape  conviction 
by  any  plea  or  defense  of  Seward. 

BUT  the  Judge  and  the  people  were  destined 
to  be  disappointed.  Freeman  was  indicted 
and  in  due  time  brought  into  court  for  ar- 
raignment. The  court-house  was  densely  packed 
by  an  eager  and  excited  crowd  of  citizens.  The 
District  Attorney  arraigned  the 
Freeman's  prisoner  on  the  several  counts  of 
Condition  the  indictment.  Freeman's  appear- 
ance was  said  to  be  that  of  a  man 
"deaf,  stupid,  unable  to  talk  connectedly  or  to 
any  sensible  purpose;  had  an  idiotic  laugh  upon 
his  face,  and,  apparently,  was  ignorant  of,  or  in- 
different to,  his  own  situation."  To  the  question, 
"Have  you  any  counsel?"  the  prisoner  replied, 
"I  do  not  know."  To  the  further  question,  "Who 
are  your  counsel?"  he  replied,  "I  don't 
know."  These  questions  led  up  to  the 
tragic  feature  of  these  proceedings.  The  Judge 
asked  the  usual  question,  "Will  any  one  defend 
this  man?"  A  death-like  hush  fell  upon  the  au- 
dience. The  report  states  that  "The  spectators 
looked  at  each  other  in  breathless  silence,  bro- 


WHO  IS  INSANE?  45 


ken  only  when  Mr.  Seward,  pale  with  emotion, 
but  with  inflexible  determination  in  every  feat- 
ure, arose  and  said,  "May  it  please  the  Court,  I 
shall  remain  counsel  for  the  prisoner  until  his 
death."  It  is  added,  "A  murmur  of  indignation 
ran  around  the  court-room  at  this  continued 
defiance,  as  it  was  regarded,  both  of  public 
opinion  and  of  public  justice." 

At  that  period  the  anti-slavery  agitation  had 
reached  a  degree  of  development  which  con- 
verted the  prejudices  of  the  great  mass  of  the 
people  against  the  negro  into  an  uncontrollable 
frenzy  when  he  committed  crimes.  Scarcely 
less  bitter  was  the  public  feeling  against  the  few 
anti-slavery  sympathizers  in  the  community 
who,  though  equally  shocked  by  the  murder,  de- 
sired to  have  a  fair  trial  given  the  criminal. 
But  nothing  could  have  occurred  which  tended 
to  arouse  greater  popular  indignation  than  the 
announcement  that  the  negro  was  to  have  as  his 
legal  adviser  and  protector  one  who,  under  the 
specious  plea  of  insanity,  had  recently  secured 
the  disagreement  of  the  jury  in  a  trial  for  mur- 
der. And  it  is  certain  that  no  man  of  less  dis- 
tinction than  Mr.  Seward  would  or  could  have 
had  the  courage  to  assume,  voluntarily,  the  po- 
sition of  counsel  for  this  self-confessed  negro 
murderer.  One  prominent  local  attorney  who 
was  impressed  with  the  conviction  that  the  pris- 
oner was  insane  or  an  imbecile,  and  that  he 


46  WHO  IS  INSANE? 


might  not  receive  fair  treatment  owing  to  the 
popular  excitement,  and  had  volunteered  to  de- 
fend him,  publicly  withdrew  from  the  case 
rather  than  face  the  storm  of  indignation  which 
awaited  the  counsel  of  the  murderer.  It  was 
the  abandonment  of  the  case  by  this  lawyer  that 
led  Mr.  Seward,  in  volunteering  to  defend  Free- 
man, to  add,  "I  shall  remain  counsel  for  the 
prisoner  until  his  death." 

MR.    SEWARD    occupied    at    that    time    a 
unique  position  in  the  political  history  of 
the  State  of  New  York.     He  had  already 
been  Governor  of  the  State  for  two  terms,  and 
took  rank  among  those  advanced  leaders  of  the 
Whig  party  who  entertained  and 
Mr.  Seward*s     occasionally    gave    utterance    to 
Position         strong    anti-slavery    sentiments. 
No  man  of  less  note  and  courage 
would  have  dared  to  appear  as  counsel  for  the 
prisoner,  and  even  he  was  denounced  by  the 
press  and  pulpit  in  unmeasured  terms,  and  the 
most  dishonorable  motives  were  attributed  to 
him  in  explanation  of  his  conduct.     Even  the 
clergyman  who  conducted  the  funeral  services 
of  the  murdered  family  had  inflamed  the  public 
mind  by  appealing  to  instincts  of  self-preserva- 
tion against  any  indulgence  of  moderation  or 
forbearance  toward  "adroit  counsel"  in  the  ef- 
forts to  lower  the  standard  of  accountability  for 
crime  by  the  plea  of  insanity. 


WHO  IS  INSANE?  47 


It  appears  from  the  record  that  Mr.  Seward 
did  not  undertake  the  defense  of  Freeman  from 
mere  sentiment,  but  that  he  thoroughly  studied 
the  case  and  became  convinced  that  the  pris- 
oner was  hopelessly  demented.  He  personally 
visited  him  in  his  cell  and  endeavored  to  con- 
verse with  him,  but  found  him  hardly  more 
than  idiotic.  He  invited  friends  to  visit  the  pris- 
oner and  study  the  case;  their  reports  confirmed 
his  experience.  He  also  engaged  the  services  of 
expert  physicians,  all  of  whom  agreed  that 
Freeman  was  suffering  from  dementia  due  to  a 
severe  injury  to  the  head  received  several  years 
before,  and  his  delusion  was  that  he  had  been 
wrongfully  confined  in  prison,  and  that  he 
would  seek  revenge  on  some  one. 

The  District  Attorney  of  Cayuga  county,  im- 
pressed with  the  gravity  of  the  situation  and  the 
favorable  character  which  Mr.  Seward  might 
give  to  the  defense,  summoned  to  his  aid  the 
Attorney-General  of  the  State,  John  Van  Buren, 
Esq.,  son  of  ex-President  Martin  Van  Buren, 
then  at  the  height  of  his  professional  and  polit- 
ical fame.  He  was  regarded  as  an  excellent  an- 
tagonist of  Mr.  Seward.  The  appearance  of 
these  famous  men  in  court  gave  additional  in- 
terest to  the  trial.  The  court-room  was  con- 
stantly crowded  and  the  town  was  filled  vdth 
strangers  interested  in  the  case. 

The  theory  of  the  defense  was  insanity,  and 


48  WHO  IS  INSANE? 


among  the  eminent  alienists  summoned  as  ex- 
pert witnesses  was  Dr.  Amariah  Brigham.  He 
was  Superintendent  of  the  Asylum  for  the  In- 
sane at  Utica,  and  was  regarded  as  the  highest 
authority  in  his  specialty  in  this  country.  He 
had  previously  seen  the  prisoner  and  fully  sus- 
tained the  theory  of  insanity.  At  the  time  of 
the  trial  he  had  desired  to  see  the  prisoner 
again  and  make  a  more  thorough  study  of  the 
case.  In  order  to  weaken,  as  far  as  possible, 
Doctor  Brigham's  testimony,  the  prosecution  re- 
fused to  allow  him  to  examine  the  prisoner  dur- 
ing the  trial.  He  was  compelled,  therefore,  to 
form  his  opinion  of  the  mental  condition  of 
Freeman  by  daily  observations  of  his  appear- 
ance and  actions  in  court. 

THE  testimony  of  Dr.  Brigham  was  regarded 
as  the  pivot  on  which  the  case  would  ulti- 
mately turn,  and  public  excitement  was  at  its 
height  when  he  was  called  to  the  witness  stand. 
I  happened  to  be  in  Auburn  on  the  day  Doctor 

Brigham  was  examined  and 
The  Testimony  witnessed  the  remarkable 
of  Dr.  Bingham     scene  which   transpired,   and 

which  has  never,  to  my 
knowledge,  been  fully  described. 

Doctor  Brigham  was  a  man  whose  personal- 
ity would  attract  attention  in  any  audience.  He 
was   very   tall   and   spare,   and   his   smoothly 


WHO  IS  INSANE?  49 


shaven  face  was  as  impassive  and  expression- 
less as  marble.  His  eyes  were  piercing  when 
fixed  on  an  object,  but  expressive  of  humor 
when  he  was  subjected  to  examination.  The 
general  impression  which  he  made  upon  the 
spectators  was  that  of  a  man  of  great  intellect- 
ual superiority,  but  who  had  the  most  perfect 
self-control.  On  his  direct  examination  he  de- 
scribed in  great  detail  the  signs  and  symptoms 
of  dementia,  and  gave  his  reasons  for  believing 
that  this  was  the  special  form  of  insanity  with 
which  the  prisoner  was  afflicted.  He  admitted 
that  his  opinion  was  based  on  his  study  and  ob- 
servation of  the  prisoner  while  in  court.  In  re- 
ply to  questions  as  to  his  ability  to  diagnose  in- 
sanity at  sight,  he  expressed  the  most  positive 
opinion  that  he  could  do  so  ordinarily,  and  had 
often  proved  his  power  to  detect  the  absence  of 
insanity  when  insanity  was  feigned,  by  observa- 
tion and  without  asking  a  question. 

On  the  cross-examination,  Mr.  Van  Buren  re- 
sorted to  every  known  strategem  and  quibble  to 
destroy  the  effect  of  these  firmly  expressed 
opinions.  He  ranged  through  the  fields  of  lit- 
erature, science,  history,  and  philosophy  to  find 
some  point  of  attack  where  Doctor  Brigham 
might  be  vulnerable,  but  in  vain,  for  he  was  met 
not  only  with  prompt  answers,  but  frequently 
the  learned  counsel  was  placed  at  a  disadvan- 
tage by  the  incisive  repartee  of  the  witness. 


50  WHO  IS  INSANE? 

The  character  of  much  of  this  part  of  the  tes- 
timony will  appear  from  quotations  from  the 
record. 

"Is  suicide  contagious?"  asked  the  counsel. 

"I  think  it  was  in  the  French  army  until  Na- 
poleon put  a  stop  to  it  by  executing  two  or  three 
suspects,"  the  witness  replied.  It  is  stated  that 
a  titter  ran  through  the  audience  and  the  Attor- 
ney-General renewed  the  charge. 

"Is  hysterics  contagious?"  he  asked. 

"It  seems  to  be  catching,"  the  Doctor  placidly 
said. 

"Suppose,  Doctor,"  said  the  counsel,  with  a 
sneer,  "that  I  should  go  out  and  steal  a  hundred 
dollars  and  then  come  in  again  and  sit  down 
here,  would  you  swear  I  was  insane?" 

"I  think  I  should,"  calmly  replied  the  Doctor. 

At  length  the  examination  took  a  more  prac- 
tical form  when  the  counsel  inquired  as  to  the 
method  pursued  by  the  witness  in  diagnosing 
insanity  at  sight.  The  witness  replied  that  he 
relied  on  the  features  of  the  patient,  which  he 
always  attentively  studied. 

"Which  feature  do  you  rely  on  in  your  diag- 
nosis?" queried  the  counsel. 

"I  rely  on  no  one  feature,  but  study  them  as 
a  group,"  was  the  answer. 

"Do  your  rely  on  the  chin?"  he  was  asked. 
"No,"  he  said.  "Do  you  rely  on  the  nose?"  was 
the  next  question.    "No,"  he  said.    "Do  you  rely 


WHO  IS  INSANE?  51 

on  the  ear?"  the  counsel  persisted.  "No,"  said 
the  witness.  "Do  you  rely  on  the  cheek?"  was 
the  next  tantalizing  question.  "No,"  was 
the  answer.  "Do  you  rely  on  the  mouth?" 
the  counsel  continued.  "Very  much,"  said 
the  Doctor.  "Do  you  rely  on  the  eyes?" 
was  the  next  question.  "Still  more  than 
on  the  mouth,"  the  witness  answered.  "If, 
then,  this  prisoner  were  concealed  all  but  his 
mouth  or  his  eyes,  you  affirm  that  you  could  de- 
cide accurately  whether  or  not  he  is  insane?" 
queried  Mr.  Van  Buren.  "No,  I  do  not  state 
that;  I  must  see  all  the  features  at  once,"  the 
witness  urged.  For  a  considerable  time  the  as- 
tute Attorney-General  dwelt  on  the  features  of 
different  persons,  endeavoring  by  his  wit  and 
sarcasm  to  throw  the  utmost  ridicule  upon  the 
witness's  method  of  detecting  insanity  at  sight. 
With  passive  countenance  and  in  the  most  quiet, 
self-possessed  manner  the  witness  answered  all 
the  questions,  exhibiting  not  the  slightest  irri- 
tation at  the  gibes  and  jeers  of  the  wily  and 
witty  counsel  as  he  held  up  to  ridicule  before 
the  jury  Doctor  Brigham's  new  method  of  diag- 
nosing insanity. 

The  interest  of  the  court,  jury,  counsel,  and 
the  immense  audience  had  gradually  increased 
as  the  examination  progressed,  until  the  ner- 
vous tension  of  the  entire  mass  of  people  had 
become  painful  and  the  suppressed  excitement 


52  WHO  IS  INSANE? 


was  intense.  The  crisis  was  reached  when  the 
Attorney-General  exclaimed,  with  startling  ve- 
hemence and  emphasis  on  every  word,  "What! 
Do  you  affirm  that  you  can  diagnose  insanity 
at  sight?"  "I  do,"  was  the  calm,  dignified,  but 
emphatic  response.  Apparently  satisfied  that 
the  climax  in  the  examination  had  been  reached, 
and  turning  towards  the  jury  and  spectators,  the 
Attorney-General  demanded  in  the  most  con- 
temptuous manner  and  tone,  "Point  out  to  the 
court  and  jury  an  insane  person  in  the  audi- 
ence." This  challenge  was  the  critical  test  of  the 
competency  of  the  witness  on  the  credibility  of 
whose  testimony  the  defense  placed  its  chief  re- 
liance. Doctor  Brigham  accepted  the  challenge 
without  a  moment's  hesitation,  and  with  an  air 
of  reserved  confidence  which  impressed  every 
one  with  belief,  or  perhaps  fear,  that  he  would 
prove  equal  to  the  emergency. 

IT  is  impossible  to  describe  the  scene  which  fol- 
lowed. A  breathless  silence  fell  upon  the 
court-room.  The  venerable  Judge  raised  his 
glasses  to  his  forehead  and  surveyed  the  excited 
mass  of  people  about  to  undergo  the  ordeal  of 

an    examination    as    to    their 

Dr.  Brigham         sanity.    The  large  number  of 

Put  to  the  Test      legal  gentlemen  within  the  bar 

arose  to  their  feet  and  gazed 
at  the  crowded  hall  and  passageways  with  in- 


WHO  IS  INSANE?  53 


tense  curiosity.  The  spectators  were  simply 
awe-stricken  when  they  reahzed  that  the  cru- 
cial test  was  to  be  applied  to  them,  and,  being 
one  of  the  number,  I  still  feel  the  thrill  of  hor- 
ror I  experienced. 

Dr.  Brigham  arose  from  his  chair  very  delib- 
erately and  stood  for  a  moment  surveying  the 
people,  as  if  to  determine  where  to  begin  his 
scrutiny.  He  was  white  and  emotionless  as  a 
marble  statue.  Turning  slowly  to  the  left  or 
first  tier  of  seats  he  began  a  deliberate  survey 
of  the  spectators,  scanning  the  features  of  each 
one  with  the  apparent  confidence  that  he  could 
detect  the  faintest  traces  of  insanity.  As  his 
keen,  searching  eyes  glanced  from  tier  to  tier  of 
seats  the  suspense  was  simply  unendurable.  He 
had  reached  the  middle  aisle  and  yet  no  one 
had  been  pointed  out  as  insane.  Five  hundred 
faces  had  been  scrutinized  and  no  group  of  indi- 
vidual features  had  responded  to  the  test. 
That  portion  of  the  audience  at  least 
breathed  more  freely.  An  incredulous  smile 
began  to  play  about  the  mouth  and  light 
up  the  mobile  features  of  the  Attorney- 
General,  while  a  greater  earnestness  of 
manner  and  intensity  of  scrutiny  were  ap- 
parent in  the  witness.  Deep  furrows  appeared 
on  his  pallid  face,  and  his  eyes  assumed  a  pierc- 
ing brilliancy  which  made  every  one  shrink  on 
whom  his  gaze  was  momentarily  fixed.    I  felt 


54  WHO  IS  INSANE? 


myself  transfixed  when  I  realized  that  my  face 
was  focalized  on  his  vision,  and  I  experienced 
a  sense  of  the  greatest  relief  when  I  saw  that  I 
had  safely  passed  the  trying  ordeal.  A  sigh  of 
relief  followed  along  the  rows  of  seats  as  the 
glance  of  the  great  expert  swept  over  them. 
The  area  of  faces  still  to  be  examined  was  now 
rapidly  diminishing,  and  but  one-fourth  of  the 
audience  remained  to  be  scanned.  It  was  ap- 
parent that  thus  far  either  there  was  no  insane 
person  in  the  crowd,  or  if  there  was,  the  witness 
had  failed  to  detect  such  person,  and  hence  had 
failed  to  answer  the  practical  test  to  which  he 
had  been  challenged  by  the  prosecution  and 
which  he  had  accepted  without  protest. 

SUDDENLY  the  wandering  eyes  of  the  expert 
became  fixed;  his  features  relaxed  and  as- 
sumed their  customary  impassiveness,  and 
it  was  evident  that  he  had  discovered  the  object 
of  his  search.    Stretching  out  his  long  arm  and 

pointing  with  his  finger 
Insanity  Recognized     toward  a  person  on  one 
at  Sight  of  the  rear  tiers  of  seats, 

he  quietly  said,  "There 
is  an  insane  man."  At  the  instant  a  man,  as  if 
struck  with  a  bullet,  sprang  from  his  seat  and, 
wildly  gesticulating  and  shouting  a  volley  of 
oaths  against  any  one  who  would  call  him  in- 
sane, rushed  down  the  aisle  toward  the  bar. 


WHO  IS  INSANE?  55 


The  Judge  rose  hastily  from  his  chair  as  if 
about  to  escape,  the  lawyers  were  panic-strick- 
en and  mingled  with  the  crowd;  but  Doctor 
Brigham  stood  perfectly  self-possessed,  while 
the  officers  struggled  with  the  lunatic  in  their 
efforts  to  remove  him  from  the  court-room. 

The  whole  scene  was  intensely  dramatic  and 
the  termination  was  a  surprising  ovation  for  the 
triumphant  actor.  Doctor  Brigham.  The  prose- 
cution was  completely  nonplussed,  and  the  wit- 
ness was  allowed  to  retire  without  further  tests 
of  his  ability  as  an  authority  in  the  di- 
agnosis of  insanity  at  sight.  The  man 
who  was  pointed  out  as  insane  proved  to  be 
a  harmless  lunatic  who  had  strayed  into 
court  from  a  neighboring  livery  stable.  To 
break  the  force  of  Doctor  Brigham's  successful 
test,  however,  the  prosecution  circulated  the 
report  that  Mr.  Seward,  in  anticipation  of  this 
test  being  made,  had  caused  the  insane  man  to 
be  placed  in  that  seat,  and  that  Doctor  Brigham 
had  previously  seen  him.  This  absurd  story 
only  heightened  the  effect  of  the  favorable  im- 
pression which  Doctor  Brigham's  successful  an- 
swer of  the  challenge  of  the  Attorney-General 
made  upon  the  court,  jury,  and  the  people. 

The  final  issue  of  the  case  was  the  conviction 
of  the  criminal  for  murder  in  the  first  degree. 
Public  feeling  would  admit  of  no  other  verdict. 


56  WHO  IS  INSANE? 


He  was  not  executed,  but  died  in  prison,  de- 
mented to  idiocy.  An  autopsy  confirmed  the 
correctness  of  the  defense — insanity. 


IV 
What  Is  Insanity? 


IV 


What  Is  Insanity? 

^LEASE  define  the  term  insanity," 
said  the  lawyer,  in  an  insinuat- 
ing tone,  to  an  expert  witness 
in  a  recent  case  where  the  issue 
in  court  was  the  insanity  of  a 
deceased       millionaire.       The 
learned  counsel  had  been  very 
suave  and  courteous  in  his  manners,  had  asked 
very  simple  questions,  and  had  complimented 
the  witness  on  his  ready  and  cor- 
An  Expert      rect  answers.     Suddenly  his  en- 
Challenged      tire  attitude  toward  the  witness 
changed.      Straightening   himself 
to  his  full  height  and  thrusting  his  thumbs  into 
the  arm-holes  of  his  vest,  he  assumed  a  most  ag- 
gressive  appearance  as  he  put   this  question, 
meantime  casting  an  inquisitive  glance  at  the 
•Jury. 

Simple  and  proper  as  the  question  appeared 
to  be,  it  was  evident  from  his  pose  and  grimaces 
that  the  astute  attorney  knew  well  the  endless 
possibilities  of  the  field  of  inquiry  upon  which 

59 


60  WHO  IS  INSANE? 

he  now  entered.  He  had  traversed  it  many 
times  before  with  learned  experts  and  had 
amused  court  and  jury  with  the  tangled  mesh 
which  he  wove  about  his  victims  in  the  form  of 
quotations  from  eminent  authorities  entirely 
contradictory  of  the  answers  of  the  witness.  He 
appeared  to  have  no  thought  or  concern  about 
the  definition  which  might  be  given.  And  the 
sequel  proved  that  Be  really  did  not  care  what 
reply  he  elicited.  Like  the  spider  in  the  center 
of  his  web,  he  could  attack  his  game  on  what- 
ever line  he  might  alight.  All  the  advantage 
which  he  asked  was  that  the  witness  attempt  a 
definition.  When  this  was  obtained,  the 
learned  casuist  immediately  proceeded  to  con- 
front the  witness  with  a  variety  of  definitions  of 
authorities  quite  unlike  that  which  he  had 
given.  The  result  of  these  quibblings  of  the  at- 
torney proved  disastrous  to  the  reputation  of 
the  alienist  witness  for  expert  knowledge  of  the 
nature  of  insanity. 

The  reckless  and  often  unscientific  testimony 
of  so-called  experts  in  cases  where  the  plea  of 
insanity  is  set  up,  especially  in  the  trial  of  crim- 
inals, has  in  these  latter  days  necessarily  but  un- 
fortunately discredited  such  evidence  in  the 
opinion  of  legal  authorities  and  the  courts. 

Taylor,  in  his  work  "On  Evidence,"  says: 
"Perhaps  the  testimony  which  least  deserves 
credit  with  a  jury  is  that  of  skilled  witnesses; 


WHO  IS  INSANE?  61 

these  gentlemen  are  usually  required  to  speak, 
not  to  facts  but  to  opinions;  and  when  this  is  the 
case,  it  is  often  quite  surprising  to  see  with  what 
facility  and  to  what  extent  their  views  can  be 
made  to  correspond  with  the  wishes  or  the  in- 
terests of  the  parties  who  call  them.  They  do 
not,  indeed,  wilfully  misrepresent  what  they 
think;  but  their  judgments  become  so  warped 
by  regarding  the  subject  in  one  point  of  view, 
that,  even  when  conscientiously  disposed,  they 
are  incapable  of  expressing  a  candid  opinion." 

JUDGE  PECKHAM,  of  the  New  York  Court  of 
Appeals,  said:     "Expert  evidence,  so-called, 
or,  in  other  words,  evidence  of  the  mere 
opinion  of  witnesses,  has  been  used  to  such  an 
extent   that   the   evidence   given   by   them  has 

come  to  be  looked  upon  with 
Expert  Evidence  great  suspicion  by  both 
Under  Reproach      courts   and   juries,   and   the 

fact  has  become  very  plain 
that  in  any  case  where  opinion  evidence  is  ad- 
missible, the  particular  kind  of  an  opinion  de- 
sired by  any  party  to  an  investigation  can  be 
readily  procured  by  paying  the  market  price 
therefor." 

In  a  recent  judicial  opinion  the  court  declared 
that  it  had  more  confidence  in  the  testimony  of 
an  ordinary  observer  as  to  the  insanity  of  a  per- 
son with  whom  the  witness  was  acquainted  than 


62  WHO  IS  INSANE? 


in  that  of  the  alienist  most  expert  in  a  knowl- 
edge of  the  technicalities  of  the  so-called  sci- 
ence of  insanity. 

Undoubtedly,  the  failure  of  expert  testimony 
to  enlighten  the  court  as  to  the  existence  or  non- 
existence of  insanity  in  a  given  case  is  largely 
due  to  the  fact  that  our  knowledge  of  the  mech- 
anism of  the  brain  and  its  functions  is  so  imper- 
fect. The  result  of  fhis  ignorance  of  the  ma- 
chinery on  which  every  mental  and  physical  act 
of  the  individual  depends  is  an  incredible 
amount  of  theorizing,  having  no  reliable  basis 
other  than  the  observation  of  mere  symptoms 
which  are  so  variable  in  different  persons  as  to 
admit  of  a  great  variety  of  interpretations. 

This  has  led  naturally  to  the  multiplication  of 
new  terms  until  the  modern  student  of  insanity 
is  confused  and  perplexed  by  definitions  be- 
yond his  capacity  of  comprehension  and  even 
memorizing.  It  is  not  surprising  that  under 
such  conditions  the  courts  are  inclined  to  attach 
little  or  no  importance  to  the  testimony  of  alien- 
ist experts,  and  that  they  are  subjected  to  un- 
sparing criticism  and  even  ridicule. 

The  fault  also  lies  in  our  loose  and  unregu- 
lated system  of  selecting  experts.  While  each 
party  in  a  suit  is  at  liberty  to  select  experts,  the 
grade  of  their  qualifications  will  be  measured 
by  other  considerations  than  learning,  skill  and 
experience. 


WHO  IS  INSANE?  63 


The  failure  of  alienist-experts  to  define  insan- 
ity, or  fix  any  definite  value  to  the  term,  is  very 
suggestive.  Is  not  the  public  justified  in  doubt- 
ing v^hether  the  commitment  of  persons  as  in- 
sane is  always  scientifically  correct,  when  even 
our  highest  authorities  are  unable  to  define  the' 
term?  Incredible,  is  it  not,  that  at  this  period 
of  advance  in  the  medical  sciences,  when  pre- 
cision in  details  is  so  exact,  that  a  definition  of 
insanity  cannot  be  formulated  of  universal  ac- 
ceptance? Does  not  this  fact  authorize  the  con- 
clusion tliat  insanity,  as  at  present  taught,  has 
not  a  scientific  basis?  Are  not  authorities  still 
seeking  a  solution  of  the  phenomena  of  the 
mind  in  the  hazy  realm  of  pure  metaphysics, 
rather  than  in  an  accurate  knowledge  of  the 
structure  and  functions  of  the  brain,  the  center 
and  source  of  all  mental  activities? 

IN  view  of  the  unsettled  opinions  of  alienists 
in  regard  to  the  definition  of  insanity,  it  has 
been  proposed  by  a  high  authority  that  an  ex- 
pert witness  should  decline  to  attempt  to  de- 
fine the  term.    And  this  seems  to  be,  at  present, 
the  true  position  to  take  in  courts 
Insanity         of  law.    Admittedly  the  term  has 
Undefinable     no  precise  clinical  nor  practical 
significance    among    physicians. 
Its   original  meaning  is   "not-sound,"   "not-in- 
health,"  a  term  applicable  to  any  sick  person. 


64  WHO  IS  INSANE? 


but  explains  nothing,  and  hence  has  no  technical 
value.  Though  the  word  "insanity"  has  been 
limited  to  disturbance  of  the  mind,  or,  more  cor- 
rectly, to  the  morbid  conditions  of  the  brain,  it 
has  no  more  importance  to  the  modern  student 
than  have  the  old  terms  "lung  disease"  and 
"liver  disease."  It  defines  nothing  and  cannot 
be  defined;  it  can  only  be  explained,  like  other 
ancient  scientific  terms  which,  in  the  develop- 
ment of  the  sciences,  have  entirely  lost  their 
former  or  original  value. 

Do  not  these  facts  suggest  that  the  terms 
"insanity,"  "lunacy,"  "lunatic,"  "mental  dis- 
ease," and  allied  words,  are  based  on  false 
premises  and  are  now  really  obsolete?  Should 
they  not,  therefore,  be  abolished  and  an  en- 
tirely new  nomenclature  be  substituted  in  iiar- 
mony  with  the  present  advanced  state  of  our 
knowledge  of  the  anatomy,  physiology  and 
pathology  of  the  brain? 

THESE  terms  are  also  very  disturbing  to  the 
insane  and  excite  the  same  resentment  when 
applied  to  them  as  when  applied  to   the 
sane.    They  take  pleasantly  to  the  terms,  "ner- 
vousness," "nervous  prostration,"  and  especially 
to    the   new   and   popular   word 
A  New  Term     "neurasthenia,"  which  is  believed 
Needed         to  be  a  disease  of  the  wealthy. 
The  public  also  attach  a  meaning 
to  the  word  "insanity"  altogether  out  of  proper- 


WHO  IS  INSANE?  65 


tion  to  its  significance  even  when  properly  em- 
ployed. "Once  insane  always  insane,"  is  a  su- 
perstition so  deeply  and  firmly  fixed  in  the 
popular  mind  that  the  mere  fact  of  having  been 
adjudged  insane  is  utterly  destructive  of  the 
future  character,  not  only  of  the  individual 
himself  or  herself,  but  of  their  children  and 
children's  children  to  the  remotest  generations. 

What  is  insanity?  has  been  the  unanswered 
question  of  the  ages.  The  ancients  referred  it 
to  the  mysteries  of  demonianism,  and  sought 
many  and  various  methods  of  exorcising  the 
evil  spirit.  Harsh  and  cruel  measures  were  re- 
sorted to  with  the  result  that  the  victim  of  in- 
sanity became  an  outcast  for  life. 

The  moderns  have  sought  an  answer  in  the 
realm  of  metaphysics,  and  have  mistaken  the 
shadow  for  the  substance,  the  symptom  for  the 
disease.  Consequently,  treatment  has  been  em- 
pirical and  without  scientific  precision.  Minis- 
tering to  the  vagaries  of  that  unknown  quantity, 
the  mind,  has  effected  few  recoveries. 

The  result  has  been  most  disastrous  to  the  in- 
sane, for  custody  and  not  cure  of  the  insane  has 
long  been  the  chief  concern  of  both  physicians 
and  managers  of  asylums.  This  is  seen  in  the 
rapidly  increasing  number  of  citizens,  for  the 
most  part  able-bodied,  living  in  idleness  in  pala- 
tial structures  built  and  maintained  at  enormous 
cost,  by  the  people.    If  the  present  rate  of  in- 


66  WHO  IS  mSANE? 


crease  of  the  insane  in  public  care  continues, 
and  no  more  successful  methods  of  treatment 
are  discovered,  the  burden  upon  the  public  for 
their  custody  and  support  will  ere  long  prove 
a  crushing  weight. 

The  failure  of  alienists  to  formulate  an  ac- 
ceptable definition  of  insanity  for  the  profes- 
sion and  for  the  courts,  suggests  that,  after  all 
these  years  of  progress,  Shakespeare,  with  mar- 
velous intuition,  included  and  concluded  the 
whole  matter  in  two  lines: 

"To  define  true  madness, 
What  is  it  but  to  be  nothing  else  but  mad?" 

But  there  is,  in  these  latter  days,  a  more  hope- 
ful outlook  for  the  insane.  Rational  methods  of 
research  are  supplanting  those  of  the  past.  In- 
stead of  merely  observing  a  few  ill-defined 
symptoms  and  attributing  them  to  some  dis- 
turbance of  the  brain  not  explained,  hence  not 
understood,  thus  reaching  a  vague  and  indefi- 
nite conclusion,  skilled  and  expert  anatomists 
and  physiologists,  inspired  by  the  scientific 
spirit  of  the  age,  are  gradually  unveiling  the 
mysteries  of  the  nervous  system,  which  has 
hitherto  remained  a  sealed  book.  These  con- 
structive students  are  thus  laying  the  founda- 
tions of  a  true  science  of  psychology  in  the  im- 
mutable facts  of  the  structure  and  functions  of 


WHO  IS  INSANE?  67 


the  ultimate  elements  of  the  brain,  the  center 
and  source  of  all  mental  activities. 

Though  the  mechanism  to  be  analyzed  and 
synthesized  is  constituted  of  the  most  subtile 
and  elusive  elements  of  the  body,  and  their  ar- 
rangement for  the  co-ordination  of  function  is 
the  most  complex  mechanism  known  to  science, 
such  progress  has  been  made  in  determining 
the  nature  of  these  units  of  the  nervous  system 
that  it  is  now  possible  to  understand  the  archi- 
tecture of  the  brain  and  to  correctly  interpret 
its  operations. 


How  We  Become  Insane 


How  We  Become  Insane 

OW  did  you  become  insane?"  I 
asked  an  Irishman  who  was 
amusing  a  group  of  inmates  of 
an  asylum.  Touching  his  fore- 
head with  his  finger  he  said, 
with  a  grimace,  "We  are  all 
built  that  way."  In  those  six 
words  he  embodied  all  of  the  knowledge  that 
science  has  discovered  in  regard  to  insanity  in 

the     centuries     past.     That 

We  are  All  short  and  crisp  answer  was 

Built  that  Way        a  more  luminous  statement 

of  the  essential  fact  of  insan- 
ity than  is  contained  in  all  the  books  on 
that,  and  the  kindred  subject  of  psy- 
chology, which  cumber  the  shelves  of  our 
public  Hbraries.  The  most  famous  cell-physiol- 
ogist required  a  volume  to  elaborate  the  same 
answer. 

Both  the  man  adjudged  insane  and  doomed 
to  the  helpless  and  hopeless  life  of  an  asylum, 
and  the  learned  medical  philosopher,  expressed 

71 


72  WHO  IS  INSANE? 


the  same  truths,  viz.,  that  in  the  constitution  of 
every  human  brain  there  are  conditions  tending 
powerfully  to  induce  mental  states  known  as  in- 
sanity. The  former  stated  this  truth  in  direct, 
concrete  form,  while  the  latter  answered  in  sci- 
entific terms  with  exact  formulas  and  abundant 
technicalities  which  only  the  most  learned 
could  read  understandingly. 

THE  story  of  the  brain,  as  scientists  have  grad- 
ually unfolded  its  intimate  structure  and 
architectural  peculiarities,  is  of  marvelous 
interest.     It  is  no  longer  to  be  regarded  and 
treated  as  a  pulpy,  homogeneous  mass  of  unor- 
ganized matter,  but  as  the  most 
The  Marvelous    highly    vitalized    and    special- 
Brain  ized  organ  of  the  body.  Though 

our  knowledge  of  its  ultimate 
structure  is  limited,  it  is  now  possible  to  explain 
in  a  familiar  way  the  anatomical  elements  of 
the  brain, — their  structure,  relations  and  func- 
tions,— and  in  that  explanation  we  discover  the 
peculiar  architectural  features  of  the  entire  ner- 
vous system,  and  how  pertinent  was  the  answer 
of  the  Irishman  to  the  question  as  to  how  he  be- 
came insane,  "We  are  all  built  that  way." 

Anatomy  teaches  that  the  ultimate  organ- 
ized element  of  every  tissue  of  the  body — bone, 
muscle,  nerve,  skin,  hair,  nails — is  a  cell.  The 
vast  importance  of  the  cell  in  the  structure  and 


WHO  IS  INSANE?  ?3 


functions  of  the  animal  economy  may  be 
learned  from  the  following  opinions  of  eminent 
physiologists : 

"The  cell  is  a  unified  organism,  a  self-con- 
tained living  being." 

"The  sole  active  principle  in  every  vital  func- 
tion." 

"The  medium  of  sensation,  will,  and  even 
thought,  the  highest  of  psychic  functions." 

"The  cell  is  not  only  like — it  actually  is —  an 
engine,  machine,  or  mechanism,  but  it  is  also  a 
living  mechanism." 

"Our  own  body  is  a  very  elaborate  social  sys- 
tem of  countless  microscopic  organisms;  a  col- 
ony or  commonwealth  made  up  of  innumerable 
independent  units." 

ERNEST  Haeckel,  the  German  scientist,  says, 
"We  have  now  ascertained  in  the  clearest, 
most  indisputable  manner,  that  all  which 
we    term    the    'soul'    is    in    a    scientific    sense 
nothing   more   than   the   total   effect   or  func- 
tion of  the  'soul  cells'  of  the  numerous  neu- 
rones in  the  brain."   What  has 
The  Brain  a       hitherto    been    known    in    the 
Cell  Structure    anatomy  of  the  brain  as  a  cell, 
nerve,  branch  (dendrite),  com- 
missure, associate  fiber,  has  been  found  to  be  a 
single  anatomical  unit,  having  as  its  base  or  ori- 
gin the  cell  proper.    This  cell,  with  its  projec- 
tions or  prolongations,  is  now  described  as  a 
single  organ  under  the  name,  "Neurone." 


74  WHO  IS  INSANE? 

The  following  histological  facts  in  regard  to 
the  nerve-cell  are  essential  to  an  understanding 
of  the  anatomy  and  physiology  of  the  nervous 
system. 

The  cell  has  its  origin  in  foetal  life  and  at 
birth  is  in  a  rudimentary  state,  but  is  endowed 
with  a  capacity  of  large  development  for  the 
performance  of  its  special  function.  It  is  es- 
timated that  there  are  between  one  and  two 
thousand  million  cells  in  the  brain  alone.  The 
physical  constitution  of  the  cell  consists  of  two 
distinct  portions,  viz.,  the  nucleus,  and  a  mass  of 
protoplasmic  matter  which  incloses  the  nu- 
cleus— the  cytoplasm.  The  intimate  structure 
of  these  bodies  has  not  been  accurately  deter- 
mined, nor  have  their  physiological  relations 
been  completely  established,  though  great  prog- 
ress has  been  made  latterly  to  that  end  by  the 
science  of  Biology  and  Physiology. 

This  protoplasmic  matter  is  so  extremely  sen- 
sitive that  the  passing  of  a  cloud  over  the  sun 
will  effect  changes  in  it  which  can  be  detected 
by  instruments  made  for  that  purpose.  Cells 
vary  in  size  from  1/250  to  1/3500  of  an  inch  in 
diameter  and  may  or  may  not  be  surrounded  by 
a  capsule. 

The  anatomist  teaches  that  the  brain-cells  are 
grouped  into  centers  according  to  their  particu- 
lar functions.  We  have  long  been  familiar  with 
the  so-called  special  senses,  which  consist  of 


WHO  IS  INSANE?  75 


collections  of  nerve  cells  and  are  known  as 
nerve-centers  with  special  functions,  viz.,  see- 
ing, hearing,  smelling,  tasting,  feeling.  These 
centers  are  designed  to  bring  the  individual  into 
conscious  relations  with  five  distinct  objective 
features  of  the  external  world  in  which  he  lives, 
moves  and  has  his  being. 

IT  IS  probable  that  comparatively  few  of  these 
centers  have  as  yet  been  accurately  deter- 
mined, but  enough  is  known  to  prove  that 
every  function,  every  act,  and  possibly  every 
thought  has  its  origin  in  special  cells  in  the  cen- 
ter of  the  cerebro-spi- 
The  Brain  Coordinates    nal   axis.    For  the  co- 
Sense-Impressions        ordination   of   the   op- 
erations of  these  innu- 
merable centers,  the  interior  of  the  brain  is  a 
mass  of  connective  nerve  fibers,  through  which 
the  intimate  relations  of  the  nerve-centers  are 
maintained,  thus  securing  the  most  perfect  har- 
mony in  the  functions  of  all  the  organs  of  the 
body.    These  fibers  are  "commissural,"  connect- 
ing the  two  hemispheres;  "projection,"  which 
project  "upon  the  cortex  of  the  brain  the  re- 
sults of  sensory  stimuli  upon  the  body;"  and 
"association,"  which  "connect  different  convo- 
lutions in  the  same  hemisphere." 

It  is  stated  that  "Were  it  not  for  the  existence 
of    these    fibers,     perception,     memory,     and 


76  WHO  IS  INSANE? 


thoughts  would  be  impossible."  Our  perception 
of  a  pear  is  incomplete  until  "we  have  fused 
into  one  mental  whole  the  sensations  from  tast- 
ing, smelling,  seeing,  touching  and  hearing  the 
fruit  fall  from  the  tree." 

Another  important  anatomical  feature  of  the 
nerve-centers  is  their  arrangement.  First,  there 
are  the  centers  of  the  special  senses  through 
which  the  individual  communicates  with  the 
external  world.  This  group  is  sometimes  called 
the  "lower  brain."  The  functions  of  these  cen- 
ters are  to  receive  the  impressions  and  transmit 
them  to  another  higher  series  of  centers,  called 
the  "mid-brain."  The  function  of  the  latter  cen- 
ters is  to  take  cognizance  of  the  special  charac- 
ter of  each  impression,  and  transmit  it  to  the 
proper  center  in  a  still  higher  grade.  This  last 
is  called  the  "higher-brain,"  which  it  is  both  in 
location,  being  in  the  frontal  part  of  the  cere- 
brum, and  in  function,  being  devoted  to  idea- 
tion, or  thinking. 

Without  going  farther  into  what  would  be- 
come tedious  anatomical  details,  let  us  con- 
sider what  the  physiologist  teaches  in  regard  to 
the  nerve-cells,  or  neurones,  and  the  nerve-cen- 
ters. First,  we  learn  that  the  cells  are  implant- 
ed at  birth  in  a  rudimentary  form  and  undergo 
an  evolution  from  the  cell  of  the  lowest  of  animal 
life  to  the  complex  cell  of  the  human  brain. 
Though  at  birth  the  cell  has  been  perfected,  so 


WHO  IS  INSANE?  77 


far  as  regards  its  structural  adaptation  to  its 
special  future  function,  yet  it  will  remain  in  an 
inert  state  and  undergo  no  further  change  or 
development  until  excited  to  activity  by  its  spe- 
cial stimulant.  For  example,  if  a  person  is  born 
blind,  the  cells  of  the  center  of  sight  will  remain 
in  a  rudimentary  state  and  undergo  no  further 
development  until  excited  by  their  proper  and 
only  stimulus — light.  The  same  is  true  of  a 
large  number  of  nerve-centers  which  are  in  im- 
mediate functional  relation  with  the  center  of 
sight. 

If  now  an  operation  is  performed  upon  the 
eye,  the  light  reaches  the  cells  of  the  center  of 
vision,  an  immediate  change  takes  place;  the 
cells  begin  to  enlarge;  the  blood  supply  is  in- 
creased, which  results  in  active  nutrition,  and 
all  of  the  related  nerve-centers  undergo  similar 
changes  as  to  activity  and  development. 

The  physiological  facts  in  regard  to  the  cells 
of  the  center  of  seeing  are  the  same  in  the  cen- 
ters of  all  the  special  senses — hearing,  feeling, 
tasting,  smelling — through  which  the  brain  as  a 
whole  is  stimulated  to  functional  activity.  It 
follows  that  in  proportion  to  the  integrity  of  the 
special  senses  is  a  human  brain  perfect,  or,  on 
the  other  hand,  defective.  It  is  also  asserted 
as  a  physiological  fact  that  if  the  apparatus  by 
which  each  of  the  nerve-centers  of  the  five  spe- 
cial senses  receives  impressions  from  the  exter- 


78  WHO  IS  INSANE? 


nal  world  were  destroyed  at  birth,  the  thou- 
sands of  millions  of  nerve-cells  of  the  brain 
would  remain  inert  and  undeveloped  during 
the  lifetime  of  the  individual. 

THIS  fact  leads  the  physiologist  to  believe  that 
in  the  human  brain  there  are  large  numbers 
of  nerve-cells  that  remain  undeveloped,  be- 
cause never  excited  to  functional  activity,  and 
also  that  at  any  period  of  life,  cells  hitherto 
inert  may  receive  their  proper 
Undeveloped    stimulus  and  take  on  functional 
Brain  Cells     activity.  Their  susceptibility  may 
be  considerably  increased  or  di- 
minished by  nutrition.    In  other  words,  we  may 
withhold  from  the  nerve-cells  the  elements  of 
nutrition  on  which  their  normal  integrity  de- 
pends, and  thus  diminish  their  power  and  sus- 
ceptibility, or  we  may  supply  them  with  nutri- 
tive materials  equal  to  the  natural  demands  of 
the  cells  and  greatly  increase  their  force  and 
susceptibility. 

If  to  the  born-blind  there  is  no  world  of  light, 
and  to  the  born-deaf  there  is  no  world  of  sound, 
may  it  not  be  a  fact  that  around  us  exist  other 
worlds  than  those  revealed  by  the  five  special 
senses,  which  we  do  not  recognize  because  the 
special  nerve-centers  for  that  purpose  have  not 
as  yet  been  stimulated  to  activity?  St.  Paul 
hints  at  this  opinion  when  he  declares  that  cer- 


WHO  IS  INSANE?  79 


tain  religious  truths  can  be  discerned  by  those 
in  whom  the  spiritual  sense  cell  has  been 
awakened.  May  not  the  strange  mental  phe- 
nomena of  dreams,  telepathy,  hypnotism,  and 
kindred  experiences  of  individuals  be  traced  to 
the  stimulation  of  nerve-centers  aroused  to  ac- 
tivity only  under  special  conditions? 

Summarizing  these  anatomical  and  physiolog- 
ical facts  we  may  formulate  the  following  con- 
clusions : 

1.  The  neurone — the  nerve-cell  and  its 
branches  of  communication — is  the  unit  of  the 
nervous  system;  there  are  thousands  of  millions 
of  them  and  their  specialized  functions  are  the 
control  of  every  organ,  and  act,  of  the  body — 
"sensation,  will,  and  even  thought." 

2.  The  intimate  texture  of  the  cell,  on  which 
its  susceptibility  and  capacity  to  perform  its 
functions  depends,  is  inherited,  but  may  be  mod- 
ified at  will  by  proper  exercise,  nutrition,  and 
conditions  of  environment. 

3.  The  germ-cell  is  implanted  at  birth,  and 
its  subsequent  development  depends  upon  its 
stimulation  to  functional  activity  by  its  appropri- 
ate stimulus;  that  is,  if  it  is  not  stimulated  it  will 
remain  inert  and  undeveloped,  thus  making  it 
possible,  by  applying  the  appropriate  stimulus, 
to  bring  into  healthy  activity  cells  long  dormant. 

4.  When  an  active  cell  ceases  to  be  stimu- 
lated it  begins  to  diminish  in  size — atrophy — 


80  WHO  IS  INSANE? 


and  will  become  inert  as  regards  its  function, 
and  will  remain  inactive  until  excited  to  activity 
by  its  special  stimulant,  showing  that  any  class 
of  cells  may  be  reduced  to  an  inert  state  and 
again  restored  to  activity  by  withholding  or  sup- 
plying their  appropriate  stimulus. 

5.  Every  cell  has  inherent  in  its  constitution 
the  power  of  selecting  from  the  blood  substances 
for  its  nutrition  and  stimulation,  and  for  which 
it  has  a  "selective  affinity."  This  feature  in  the 
constitution  of  the  cell  enables  us,  by  means  of 
the  appropriate  remedies,  to  increase,  diminish, 
or  pervert  its  action. 

6.  In  the  structural  arrangement  of  the  neu- 
rones they  are  grouped  into  "centers"  according 
to  their  special  functions;  in  these  centers  the 
cells  communicate  with  each  other  by  means 
of  innumerable  branches — dendrites — while  the 
centers  communicate  with  each  other  through 
nerve-fibers  known  as  commissures.  In  the 
grouping  of  these  centers  there  is  a  perfectly 
logical  and  orderly  series  of  sequences  by  which 
impressions  are  made,  received,  and  responded 
to  on  the  part  of  the  centers,  so  as  to  secure  the 
most  perfect  harmony  in  all  of  the  acts,  func- 
tions, and  even  thoughts,  of  the  individual. 

7.  The  fundamental  grouping  of  the  nerve 
centers  was  designed  to  bring  the  individual 
into  proper  relation  with  the  external  world — 
the  source  of  all  power — and  hence  we  have. 


WHO  IS  INSANE?  81 

first,  the  centers  of  the  five  special  senses,  see- 
ing, hearing,  smelling,  tasting,  and  feeling;  from 
these  the  impressions  are  conveyed  to  other  cen- 
ters closely  allied  in  function,  until  they  finally 
reach  their  destination  in  the  cerebral  centers, 
the  seat  of  the  "highest  psychic  function,"  and 
where  the  inhibitory  centers  control  all  volun- 
tary acts. 

8.  Every  nerve-cell  has  its  own  special  func- 
tion, and  these  functions  are  as  numerous  as  the 
acts  and  even  the  thoughts  of  the  individual, 
but  each  depends  ultimately  for  its  activity  and 
development  upon  the  stimulation  which  it  re- 
ceives from  one  of  the  five  special  senses, 
through  the  medium  of  association  fibers. 

From  the  preceding  summary  of  anatomical 
and  physiological  facts  we  may  conclude  that 
every  vital  function,  as  well  as  every  mental 
operation,  thought,  word  and  act  has  its  ori- 
gin and  expression  in  one  or  many  of  these  en- 
tities or  units  of  the  nervous  system.  Their  com- 
bined physiological  functions,  in  health,  consti- 
tute the  normal  individuality  of  the  person, 
mentally  and  physically. 

If  we  now  consider  the  extreme  susceptibility 
of  these  bodies  to  the  innumerable  variety  of  im- 
pressions to  which  they  are  exposed,  external 
and  internal  to  the  body,  we  can  form  some 
conception  of  how  unstable  their  functions  may 
be.    Their  own  structure  is  constantly  undergo- 


82  WHO  IS  INSANE? 


ing  change  in  the  act  of  nutrition.  Their  integ- 
rity thus  depends  upon  the  absorption  and  re- 
moval of  dead  tissue  and  its  replacement  with 
suitable  nourishment.  If  the  dead  matter  is  not 
promptly  removed,  or  if  the  food  of  the  individ- 
ual is  not  suitable,  the  neuron  is  no  longer  in 
health  and  must  perform  its  function  less  per- 
fectly. 

They  are  also  extremely  susceptible  to,  and 
receptive  of,  impressions  derived  from  the  ex- 
ternal world.  Thus  they  are  affected  by  the 
food  we  eat  and  the  fluid  we  drink;  by  diseases 
of  every  kind  which  afflict  the  body;  by  every- 
thing recognized  by  the  senses. 

IT  follows  that  any  change  in  the  constitution 
or  structure  of  the  cell  or  neuron  must  be  at- 
tended  by    a    derangement   of   its    function 
which  would  find  expression  in  the  mental  acts 
of  the  individual.     If  a  group  of  cells  should 
from  any  cause  cease  to  act,  the 
The  Cause  of     mental    attributes    which    they 
Derangement     manifest,  when  acting  normally, 
must    cease.    Equally,    if    the 
same  cells  are  over-stimulated,  their  functional 
activities   are   correspondingly  increased.     Or, 
again,  if  the  structural  properties  of  the  cells  are 
changed,  as  by  alcoholic  intoxication  or  by  any 
other  toxic  agent  which  finds  access  to  the  brain 
and  for  which  any  cells  have  an  affinity,  the 


WHO  IS  INSANE?  83 

mental  functional  expression  would  be  changed 
to  the  extent,  and  in  the  particular  feature,  that 
the  affected  bodies  contribute  to  the  mentality 
and  personality  of  the  individual. 

Thus,  if  certain  intoxicants  are  administered, 
the  change  effected  in  the  constitution  of  the 
bodies  devoted  to  the  function  of  seeing  are 
such  that  external  objects  assume  new  forms, 
technically  causing  an  illusion  of  sight.  The 
experimental  physiologist  can,  at  will,  with  cer- 
tain toxins,  change  the  action  of  groups  of  cells 
so  that  the  individual  will  exhibit  certain  men- 
tal traits  entirely  foreign  to  his  usual  habit  of 
thought  and  expression. 

In  various  forms  of  sickness  the  temper  and 
conduct  of  the  patient  undergo  marked  changes; 
he  often  becomes  delirious,  due  to  the  changed 
conditions  of  nutrition  caused  by  toxins  in  the 
blood  or  by  the  various  forms  of  disease.  Auto- 
intoxication, on  which  modern  therapeutists 
place  so  much  stress,  finds  its  most  frequent  ex- 
pression in  the  vagaries  of  character  which  the 
toxins  generated  in  that  great  culture  bed,  the 
colon,  produce  on  the  nerve-cells. 

The  old-time  remedy  for  persons  of  gross 
habits  of  overfeeding — blue  pill  at  night  and  a 
seidlitz  powder  in  the  morning — has  changed  a 
sour  to  a  sweet  temper.  An  English  clergyman 
who  had  many  wealthy  parishioners  was  accus- 
tomed, when  summoned  to  minister  to  the  spir- 


84  WHO  IS  INSANE? 


itual  wants  of  a  certain  class,  to  send  the  appli- 
cant several  pills  with  the  request  that  they  be 
taken  at  bed-time  and  the  promise  that  he 
would  call  on  the  following  day.  The  famous 
philosopher,  Dr.  Samuel  Johnson,  declared  in 
his  vehement  manner  that  every  sick  man  is  a 
rascal. 

IN  health  the  individual  exhibits  ever-varying 
"moods    of    mind,"    owing    to    the    constant 
changes  in  cell  structures  or  neurons,  due  to 
nutrition  and  the  infinite  number  and  kind  of 
impressions  acting  upon  them  from  within  and 

from  without  the  body.  We 
Our  Ever-Varying    are  not  the  same  in  every 
Moods  respect   this  year   that  we 

were  last  year,  this  month 
that  we  were  last  month,  this  evening  that  we 
were  this  morning.  The  wise  Diotima  said  to 
Socrates  (The  Symposium  of  Plato) :  "In  the 
same  individual  there  is  succession  and  not  ab- 
solute unity;  a  man  is  called  the  same;  but  yet 
in  the  short  interval  which  elapses  between 
youth  and  age  .  .  .  he  is  undergoing 
a  perpetual  process  of  loss  and  reparation. 
And  this  is  true  not  only  of  the  body  but  also  of 
the  soul,  whose  habits,  tempers,  opinions,  de- 
sires, pleasures,  pains,  fears,  never  remain  the 
same  in  any  one  of  us,  but  are  always  coming 
and  going." 


WHO  IS  INSANE?  85 

In  the  ultimate  elements  of  the  brain,  then, 
science  is  seeking  the  true  explanation  of  the 
mental  phenomena  which  characterize  the  va- 
rious phases  of  insanity.  A  learned  authority 
has  thus  tersely  stated  the  conclusions  of  sci- 
ence :    "As  his  neurones  are,  so  the  man  is." 

THE  nerves,  or  axones  of  the  cells,  are  classi- 
fied, in  general,  according  to  their  func- 
tions as  follows:  First,  sensory,  or  those 
conveying  impressions  or  sensations  to  the  cen- 
ters (afferent) ;  second,  motion,  or  those  convey- 
ing impulses  from  the  centers  to 
The  Nerves  the  muscles  (efferent) ;  third,  in- 
Classified  hibitory,  or  those  which  control 
the  functions  of  the  two  former. 
The  practical  action  of  these  groups  of  neurones 
may  be  illustrated  in  such  familiar  acts  as  the 
following :  We  touch  a  pin-point  with  the  finger 
in  the  dark;  the  impression  or  sensation  is  in- 
stantly conveyed  to  a  nerve-center  through  the 
sensory,  or  afferent  nerve,  which  has  been  con- 
tinued at  its  terminal  extremity  in  the  skin  at  the 
tip  of  the  finger;  this  sensation  stimulates  the  cell 
which  generates  the  nerve  force,  to  send  out  an 
impulse  through  the  motor  or  efferent  nerve  to 
the  muscles  of  the  arm,  and  the  hand  is  as  in- 
stantly withdrawn  from  contact  with  the  pin. 
Such  would  be  the  natural  or  physiological  ac- 


86  WHO  IS  INSANE? 


tion  of  this  group  of  nerves,  or  neurones.  But  if 
we  add  to  the  illustration  the  further  fact  that 
we  are  searching  for  that  pin  and  would  be  lia- 
ble to  lose  it  if  the  finger  was  removed  from 
contact  with  its  point,  there  comes  to  our  aid 
another  nerve-center,  which  has  been  aroused 
to  activity,  which  inhibits  the  removal  of  the 
hand  by  controlling  the  action  of  the  muscles 
of  the  arm  and  compels  us  to  maintain  contact 
with  the  pin  until  it  is  secured.  This  simple  il- 
lustration explains  the  differences  which  we 
daily  witness  in  the  conduct  of  persons  under 
similar  conditions;  one  is  quiet  and  apparently 
indifferent  whatever  the  cause  of  excitement, 
while  another  weeps  and  screams;  in  the  former 
the  inhibitbry  centers  completely  control  the 
acts  of  the  person,  while  in  the  latter  they  have 
lost  temporary  influence  over  the  disturbed 
centers.  With  the  insane  the  inhibitory  centers 
exercise  little  or  no  control  generally  over  those 
disturbed  and  hence  their  thoughts,  words  and 
acts  betray  their  mental  derangement. 

A  familiar  illustration  of  this  regulating 
power  of  a  class  of  nerve-centers  over  the  opera- 
tions of  another  class  is  seen  in  the  "governor" 
of  the  machine  whose  impelling  force  is  steam. 
Without  this  regulator,  which  always  pre- 
serves an  equilibrium  in  the  constantly  varying 
force  of  the  steam,  the  machine  would  soon  be 
destroyed. 


WHO  IS  INSANE?  87 


It  follows  from  this  review  of  the  structure 
of  the  brain,  and  the  physiological  processes  in 
the  performance  of  its  functions,  that  sanity,  or 
a  sound  mind,  depends  upon  the  harmonious 
relations,  at  all  times  and  under  all  conditions, 
of  the  individual  vital  units — the  cells,  thou- 
sands of  millions  in  number —  which  constitute 
the  human  brain.  And  these  cells  are  so  sensi- 
tive and  impressionable,  as  noted,  that  they  are 
affected  by  the  passage  of  a  cloud  over  the  sun. 

THAT  any  kind  of  harmony  of  action  in  such 
a  vast  colony  of  independent  living  bodies, 
performing  an  immense  variety  of  differ- 
ent functions,  can  be  maintained,  even  for 
a  moment,  amid  the  distracting  excitements  and 
discordant  influences  of  modern  life,  is  amaz- 
ing.    That  the  average  man 
The  Wonder  That  should  be  able  for  a  lifetime 
Any  Are  Sane        to  preserve  such  a  degree  of 

sanity  as  will  save  him  from 
commitment  to  a  lunatic  asylum  can  be  ex- 
plained only  by  a  marvelous  conservation  of 
nervous  energy  and  inhibitory  power  in  the 
coordination  of  functions  of  the  nerve-centres 
inherent  in  the  constitution  of  the  nerve-cells. 
Truly  did  the  pious  hymnist,  Dr.  Isaac  Watts, 
sing: 

"Strange  that  a  harp  of  a  thousand  strings. 
Should  keep  in  tune  so  long." 


88  WHO  IS  mSANE? 


Disturbances  of  the  harmony  of  the  brain 
cells  are  more  frequently  transient  in  their  ef- 
fect. They  quickly  recover  their  normal  condi- 
tion when  the  exciting  cause  is  removed,  or 
ceases  to  act.  These  functional  disturbances  of 
the  action  of  the  cells  cannot  be  classed  as  any 
form  of  disease,  for  the  structure  of  the  cell  re- 
mains unchanged.  If,  however,  the  tissue  of  the 
cell  becomes  changed  in  its  intimate  nature,  so 
that  the  function  of  the  cell  is  not  restored,  a 
condition  of  disease  exists.  In  a  recent  decision 
of  a  United  States  Court  of  Appeals  it  was  held 
that  "the  term  'disease'  was  not  intended  to 
cover  and  did  not  apply  to  a  temporary  de- 
rangement of  the  functions  of  some  organ,  as, 
for  example,  of  the  stomach." 

The  most  familiar  illustration  of  the  nervous 
system  is  the  telegraph.  The  resemblance  is  so 
striking  that  it  has  been  alleged  that  the  latter 
was  modeled  after  the  former. 

THERE  is  the  central  station  communicaang 
with  the  external  world  by  its  cables  to  for- 
eign countries  which  corresponds  with  our 
brain-centres  and  nerves  of  special  sense;  the 
central  station  has  its  cells  generating  the  elec- 
trical force  as  the  brain- 
The  Nerve-System       centre's  nerve-cells  gener- 
Telegraph  ate  the  nervous  force ;  from 

the   electric   cells  proceed 
wires  to  other  telegraph  centres  as  do  the  nerves 


WHO  IS  INSANE?  89 


from  the  nerve-cells  to  the  other  nerve 
centres;  and  from  the  terminal  telegraph 
station  the  message  is  delivered  as  from  the  ter- 
minal ends  of  the  nerves  the  messages  of  the 
brain-cells  of  ideation  are  delivered  to  the  mus- 
cles and  organs  v^hose  functions  are  the  protec- 
tion and  preservation  of  the  life  of  the  body. 

It  is  not  difficult  to  understand  how 
easily  the  telegraph  system  may  become  so  de- 
ranged as  to  give  wrong  or  imperfect  messages. 
If  the  operator  who  receives  the  cable  messages 
from  the  outside  world — Europe,  Asia,  Africa, 
Islands  of  the  Sea — wrongly  interprets  the  signs 
through  some  defect  in  his  electrical  apparatus, 
however  slight,  the  messages  which  he  transmits 
to  other  centers  in  this  country  will  be  wrong 
and  the  final  news  given  to  the  people  will  be 
false.  The  same  is  true  of  every  telegraph  cen- 
tre in  the  entire  system. 

Comparing  this  illustration  with  the  action  of 
the  nervous  system,  we  note  that  if  the  cells  of  a 
nerve-centre  of  special  sense — seeing,  hearing, 
touching,  tasting,  smelling — through  and  by 
which  we  have  some  knowledge  of  the  external 
world,  fail  to  perform  their  functions,  wrong 
impressions  will  be  conveyed  to  other  nerve- 
centres,  and  while  this  condition  lasts  the  per- 
son is  of  unsound  mind,  or  insane. 


PART  TWO 

CRITICAL  PERIODS  OF  LIFE  PREDISPOS- 
ING  TO  INSANITY 


VI 

Childhood 


VI 


Childhood 


HE  pertinency  of  the  reply,  "We 
are  all  built  that  way,"  becomes 
more  apparent  when  we  review 
the  normal  and  physiological 
changes  which  the  human  sys- 
tem undergoes  at  different  pe- 
riods of  life.  Childhood,  the 
period  from  birth  to  adolescence,  is  full  of  possi- 
bilities for  good  and  for  evil  to  the  infantile 

brain.  The  nerve-centres  are 
peculiarly  sensitive  and  are 
especially  retentive  of  the 
first  impressions  made  upon 
them.  "Just  as  the  twig  is  bent  the  tree's  in- 
clined" is  an  old  and  extremely  useful  axiom 
to  those  responsible  for  the  care  and  training  of 
children.  Immature  as  the  child  seems  during 
its  first  decade,  impressions  may  be  made  upon 
the  sensitive  elements  of  its  brain  which  will 
finally  control  the  whole  mental  life  of  the  indi- 
vidual. 

St.  James's  description  of  the  power  of  the 

95 


Possibilities  for 
Good  or  Evil 


96  WHO  IS  INSANE? 


tongue  for  mischief  is  an  apt  illustration  of  the 
final  result  of  a  single  disturbed  nerve  centre. 
He  declares  that  though  the  tongue  is  a  "little 
member,"  it  is  "a  world  of  iniquity;"  it  "defileth 
the  whole  body;"  it  "setteth  on  fire  the  course 
of  nature;"  it  "is  set  on  fire  of  hell."  He  com- 
pares it  to  a  spark  which  kindles  a  forest  fire. 

THIS  is  a  graphic  illustration  of  the  power  of 
a  few  over-stimulated  nerve-cells  to  extend 
their  influence  gradually  until  they  finally 
dominate  the  entire  life  of  the  individual.     If 
this  excessive  stimulation  is  not  promptly  cor- 
rected, and  these  few  infinitesi- 
Domination      mal  organisms  are  not  brought 
By  a  Few  Cells  into  harmonious  relations  with 
their  fellows,  they  may  prove  to 
have  been  set  on  fire  of  hell;  to  contain  a  world 
of  iniquity;   to   have  the  power  to   defile   the 
whole  brain;  to  set  on  fire  the  whole  course  of 
nature.    In  the  light  of  these  facts,  consider  the 
following  illustrative  cases : — 

A  bright,  nervous  schoolboy  began  to  practice 
personal  cleanliness.  He  was  so  infatuated  with 
this  impression  that  it  gradually  became  the  ab- 
sorbing purpose  of  his  existence.  He  brushed 
his  clothes  many  times  daily;  wiped  his  shoes 
frequently  with  a  pocket  handkerchief;  never 
crossed  the  street  except  on  a  clean  cross-walk; 
always  brushed  the  seat  before  sitting  down. 


WHO  IS  INSANE?  97 


At  twenty  years  of  age  the  habit  had  in- 
creased so  that  he  examined  his  Hnen  for  specks 
of  dirt  with  a  magnifying  glass,  before  he  would 
use  it;  placed  a  chair  beside  his  bed  on  retiring, 
on  which  he  would  stand  while  undressing  and 
from  which  he  might  step  into  his  bed,  and  thus 
not  soil  his  feet  by  stepping  on  the  floor;  wore 
gloves  constantly  while  at  business  that  he 
might  not  touch  the  bare  hand  of  another  in 
shaking  hands;  carried  a  handkerchief  in  his 
hand  much  of  the  time  with  which  he  frequent- 
ly brushed  his  coat  collar.  He  became  a  suc- 
cessful merchant  in  New  York,  married  and 
reared  a  family  of  children,  and  was  greatly  re- 
spected by  business  men  and  by  a  large  circle  of 
social  and  church  associates.  He  showed  no  dis- 
position to  enforce  his  own  habits  of  thought 
and  action  upon  others,  nor  did  his  peculiar 
personal  neatness  and  cleanliness  attract  other 
attention  than  that  of  admiration. 

AT  FIFTY,  having  acquired  a  competence,  he 
retired  from  the  more  active  duties  of  his 
business  and  built  a  very  costly  house  in  a 
suburban  village.    Relieved  by  his  co-partners 
of  constant  attention  to  the  details  of  a  diversi- 
fied  business,    and    thus    de- 
A  Mania  prived  of  the  hourly  contact 

for  Cleanliness      with  a  great  variety  of  men, 

he  concentrated  his  thoughts 
more    and    more    upon    his    new    residence, 


98  WHO  IS  INSANE? 


especially  as  it  approached  completion.  As 
room  after  room  was  finished  he  would  daily 
clean  it  and  lock  the  door  that  no  one  should 
soil  the  floors  in  his  absence.  On  the  comple- 
tion of  his  palatial  residence  he  spent  hours  in 
dusting  and  cleaning,  and  became  very  irritable 
when  he  was  advised  to  give  more  attention  to 
business  and  less  to  cleaning  his  house. 

It  required  but  a  twelve  month  of  isolation 
from  business,  which  had  formerly  maintained 
a  fair  degree  of  harmony  among  the  brain-cells 
by  healthful  devotion  to  their  normal  functions, 
for  those  cells,  so  long  since  set  on  fire  of  hell, 
to  defile  the  whole  body  of  cells,  and  set  on  fire 
the  whole  course  of  nature.  He  became  more 
and  more  morose,  and  could  not  be  diverted 
from  his  favorite  employment  of  cleaning. 

The  result  of  this  life-long  aberration,  begin- 
ning with  the  deranged  function  of  a  few  nerve- 
cells,  or  neurones,  was  the  defilement  of  the 
whole  brain,  commitment  to  an  asylum,  and 
finally  death,  while  in  the  act  of  dusting  his  bed- 
clothes. His  brain  was  all  aflame  with  the  fire 
which  a  spark  had  kindled. 

A  medical  student,  by  the  name  of  Jones,  lin- 
gered after  the  class  was  dismissed,  and,  after 
some  hesitation,  stated  that  he  had  long  been 
disgusted  with  the  name  Jones.  I  replied  that 
it  was  a  very  convenient  name,  one  which  no 
person  could  easily  forget,  and  hence  useful  for 


WHO  IS  INSANE?  99 


a  professional  man.  He  expressed  a  strong  dis- 
like of  the  name  and  said  he  was  determined  to 
change  it.  He  was  a  good  scholar,  very  precise 
in  all  his  acts,  a  perfect  gentleman  in  his  de- 
portment, but  very  sensitive  to  criticism  of  ev- 
ery kind.  In  due  time  he  graduated  among  the 
best  students  of  the  class.  The  Civil  War  began 
soon  after  his  graduation  and  he  entered  the 
service  of  the  Medical  Department.  He  made  an 
excellent  record  and  at  the  close  of  the  war  took 
rank  with  the  best  officers  in  the  army. 

After  the  war  he  was  assigned  to  a  Military 
Department  in  the  West,  where  he  led  a  very 
quiet  life.  About  fifteen  years  after  his  gradua- 
tion I  received  a  newspaper  from  him  with  a 
mark  at  the  official  records  of  a  court,  which 
made  public  the  fact  that  on  application  to  a 
court  he  had  legally  changed  his  name  by  in- 
corporating his  first  name,  Harvey,  with  the 
second,  making  it  Harvey- Jones,  and  assuming 
as  his  first  name.  Tames.  I  acknowledged  the 
receipt  of  the  paper,  and,  without  men- 
tioning the  fact  that  1  had  noticed  the 
change  in  his  name,  directed  my  letter  to 
Dr.  Harvey  Jones,  as  formerly.  He  replied 
promptly  and  called  my  attention  to  our  con- 
versation a  score  of  years  before,  when  he  de- 
clared his  intention  to  rid  himself  of  the  name, 
Jones,  and  directed  me,  if  I  ever  addressed  an- 
other letter  to  him,  to  remember  his  present 
name. 


100  WHO  IS  INSANE? 

Several  years  elapsed,  during  which  I  occa- 
sionally heard  from  my  student  at  different 
posts.  An  army  officer  who  had  been  at  the 
same  station  with  him  for  a  time  informed  me 
that  the  Doctor  was  generally  regarded  as  a 
"crank"  in  many  matters  and  on  several  occa- 
sions had  appeared  quite  "luny,"  especially 
when  anyone  accidentally  called  him  Jones. 

LATER  in  life,  when  he  had  reached  the  age  of 
fifty-five,  an  army  officer  wrote  me  request- 
ing my  good  otfices  in  endeavoring  to  in- 
duce my  former  student  to  write  his  name  in 
full  on  the  Government  pay-roll.    I  learned  that 
latterly  the  Doctor  had  begun  to 
Mania  drop    the   letter   "o"   from   the 

Over  a  Name  "Jones"  part  of  his  name,  and 
that  the  Secretary  of  the  Treas- 
ury, having  been  informed  that  there  was  no 
person  of  that  name  in  the  army  service,  had  re- 
fused to  pay  his  salary  any  longer;  that  all  ef- 
forts to  induce  him  to  spell  his  name  correctly 
were  violently  resented;  that  he  had  declared 
that  he  would  never  write  his  full  name  under 
any  circumstances,  and  would  prosecute  the 
Secretary  if  he  persisted  in  refusing  payment. 
Accordingly,  I  wTote  a  very  conciliatory  letter  to 
him,  being  careful  to  direct  it  in  accordance  with 
his  known  wishes.  It  brought  me  a  letter  in  re- 
ply in  which  he  refused,  under  any  circum- 


WHO  IS  INSANE?  101 

stances,  to  comply  with  the  Secretary's  request. 
The  result  was  a  suit  against  the  Secretary  to 
compel  payment,  a  verdict  sustaining  the  Secre- 
tary, and  the  dismissal  of  the  surgeon  from  the 
army  service.  He  retired  to  private  life.  Free 
from  all  duties,  oppressed  with  the  dread  of  im- 
pending poverty,  goaded  by  a  feeling  of  wrong 
treatment  by  the  Secretary  and  army  officers 
who  had  urged  him  to  sign  his  name  in  full,  his 
whole  brain  rapidly  became  involved  and  his 
life  was  soon  cut  short  by  an  acute  disease. 

WHAT    intensely    interesting    lessons    these 
cases    teach,    and    yet    how    differently 
will   they  be  interpreted!     One   class   of 
alienists,  who  know  the  brain  only  as  a  mass  of 
homogeneous  matter,  will  regard  them  as  strik- 
ing illustrations  of  the  incurable 
The  Lesson       nature  of  insanity,   confirming 
of  Such  Cases    the  theorj^  "once  insane  always 
insane."     The  younger  student 
will  recognize  them  as  stupidly  neglected  cases 
of  mere  functional  derangement  of  a  few  nerve- 
cells,  that  might  either  have  been  restored  to 
their   normal   condition   by   early   and   proper 
treatment,  or  have  been  reduced  to  a  state  of 
"innocuous  desuetude"  in  later  life. 

To  the  public  the  lesson  of  these  cases  is  full 
of  significance.  How  rare  the  family  of  many 
children  in  which  the  parents  fail  to  detect  in 


102  WHO  IS  INSANE? 


some  one,  or  several  of  the  group,  a  trend  of 
thought  or  action  not  in  harmony  with  right  de- 
velopment of  character!  But  no  other  notice  is 
taken  of  it  than  a  passing  remark  that  the  child 
is  peculiar,  and  the  spark  that  is  destined  to  en- 
velope the  w^hole  brain  in  conflagration  is  al- 
lowed to  smoulder,  with  occasional  marked  in- 
terruptions, until  in  later  life  it  flames  forth 
in  every  thought  and  act  of  the  individual,  now 
a  fit  subject  for  a  custodial  institution,  whose 
hospitable  doors  always  open  inwards  for  the 
reception  of  such  disturbers  of  the  peace  and 
rarely  open  outwards  for  their  discharge. 

Not  less  suggestive  are  these  cases  to  the 
teacher  of  youths.  In  his  daily  intercourse  with 
his  pupils  he  constantly  meets  with  such  in- 
stances of  tendencies  to  vicious  development  of 
the  brain,  which  could  be  changed  either  by  re- 
moving all  sources  of  stimulation  of  the  nerve- 
centres  involved,  or  by  counteracting  their  nu- 
trition through  the  diversion  of  blood  to  other 
parts  of  the  brain.  Infinite  are  the  possibilities 
of  developing  one  section  of  the  brain  at  the  ex- 
pense of  another.  Bandage  a  child's  eyes  and 
he  will  depend  upon  the  ear  for  knowledge  of 
events  occurring  around  him,  and,  meantime, 
the  nerve-cells  of  sight  will  waste,  while  those 
of  hearing  will  correspondingly  increase. 

And,  finally,  the  lesson  comes  home  to  every 
individual.    We  recognize  tendencies  to  thought 


WHO  IS  INSANE?  103 

and  action  that  we  know  will  end,  if  al- 
lowed to  develop  without  restraint,  in  the 
formation  of  habits  which  may  entirely  change 
character.  These  personal  peculiarities,  of 
which  we  are  conscious,  are  quite  under  our 
control  for  long  periods,  and  even  late  in  life. 


VII 

Adolescence 


YLl 

Adolescence 

jDOLESCENCE  is  defined  to  be 
the  period  of  life  between  pu- 
berty and  the  full  development 
of  the  frame,  extending  in  man 
from  about  the  age  of  fourteen 
years    to    twenty-five,    and    in 
woman  from  twelve  to  twen- 
ty-one.   It  is  truly  the  beginning 
of  the  enlarged  and  perfected  life  of  the  individ- 
ual, or,  rather,  it  is  having  life  more  abundantly. 
What  is  its  real  nature  and  im- 
Life  More        port?  It  marks  the  development 
'Abundantly       of  a  new  element  in  the  constitu- 
tion of  the  nervous  sj^stem.  Even 
at  birth  nature  had  made  provision  for  the  per- 
petuation of  the  species  by  implanting  in  the 
nervous  centres  certain  cells  specifically  devoted 
to     that     function.    They     remain      dormant 
until    adolescence,    when    they    begin    to    de- 
velop and  take  on  functional  activity.  Hitherto 
youths,    both    male    and    female,    associated 
freely   together  as  boon   companions,   but  on 

107 


108  WHO  IS  INSANE? 


reaching  the  above  ages,  respectively,  a  new  ele- 
ment in  their  conscious  relations  arises,  a  sen- 
timental distinction,  which,  though  "probably 
the  most  profound  and  most  nearly  universal 
attribute  of  organized  beings,"  is  so  subtle  in  its 
development  and  expression  that  its  origin  and 
purport  are  not  recognized. 

THE  simple  truth  is  that  a  new  and  trans- 
forming force  has  appeared  in  the  nervous 
constitution  of  both,  which  is  destined  to 
dominate  every  faculty  and  determine  largely  the 
mental  and  moral  character  of  the  adult  indi- 
vidual.   If  the  strong  pas- 
Dormant  Nerve-        sions    which    have    been 
Centres  Awakened      aroused     find     full     and 

healthful  play,  the  high- 
est type  of  manhood  and  womanhood  is  devel- 
oped, but  if  they  are  diverted  from  their  normal 
functional  activities  and  affinities  the  integrity 
of  the  mental,  moral  and  physical  constitution 
of  the  individual  is  threatened  with  disaster. 

With  the  awakening  of  these  long  dormant 
nerve-centres  to  functional  activity,  the  affect- 
tive  faculties  receive  a  rich  endowment  of  per- 
ception. Every  sense-nerve-centre  becomes 
more  developed  and  active,  and  sights,  sounds, 
odors,  tastes  and  feelings,  hitherto  unknown,  are 
recognized.  So  profound  are  the  effects 
wrought  by  this  new  and  impelling  force,  that 


WHO  IS  INSANE?  109 


the  personality  of  the  individual  often  appears 
to  undergo  a  complete  change.  But  that  change 
is  markedly  different  in  the  two  sexes. 

The  form  of  the  female  expands  and  becomes 
more  symmetrical;  her  features  assume  a  firm, 
inquisitive  expression;  she  is  no  longer  the 
romping,  rollicking,  daring  leader  in  the  sports 
of  her  playmates,  but  is  shy,  sensitive,  emotion- 
al; she  becomes  so  impressionable  that  a  word 
may  cause  an  ecstacy  of  joy,  or  excite  an  out- 
burst of  passionate  grief.  Suddenly,  without 
preparation  or  premeditation,  a  smile,  a  tear,  a 
word,  a  touch,  transforms  her  boy-companion 
from  a  simple  playmate  to  a  sensuous,  ideal- 
ized being,  whose  presence  hereafter  will  have 
a  strange,  irresistible  fascination  which  charms 
every  sense.  Quite  unconsciously  she  seeks  by 
various  arts  to  increase  her  personal  attrac- 
tions; she  studies  grace  in  attitude  and  manners, 
style  in  dress,  precision  in  speech.  Her  entire 
personality  has  undergone  such  a  marvelous 
change  that  her  former  self  can  scarcely  be  rec- 
ognized. 

Not  less  apparent,  but  radically  different,  are 
the  influences  of  adolescence  upon  her  boy-com- 
panion when  he  reaches  the  age  of  fourteen 
years.  The  implanted  hair-bulbs  of  his  face, 
dormant  until  adolescence,  become  active  and 
soon  change  his  features;  his  voice  assumes  a 
grave,  commanding  tone;  his  bones  lengthen, 


110  WHO  IS  INSANE? 


his  muscles  strengthen,  his  chest  broadens;  he 
moves  with  dehberation;  he  speaks  hke  one 
born  to  command,  and  his  attitude  toward  oth- 
ers is  that  of  a  master. 

Ambition  stimulates  every  energy  to  intense 
activity;  he  becomes  aggressive,  contentious,  de- 
fiant; he  is  imperious,  and  when  opposed  or 
baffled  in  his  efforts,  resorts  to  extreme  phys- 
ical measures  to  accomplish  his  purposes.  His 
girl-companion,  by  her  modesty  and  shyness, 
appeals  for  protection  to  his  sense  of  superiority, 
and  he  proudly  assumes  her  care  and  makes  her 
an  idealized  vassal  in  the  realm  of  his  affections. 
Adolescence  has  wrought  in  his  personality  a 
change  not  less  striking,  but  entirely  opposite  in 
all  of  its  manifestations,  from  that  of  his  boy- 
hood playmate. 

THE    normal    physiological    significance    of 
these   peculiar   changes   of   character   and 
conduct  of  adolescents  is  efflorescence  of  the 
affective  faculties,  due  to  the  awakening  of  their 
nerve-centres   to   functional   activity.     The   ex- 
pression of  these  faculties  is 
The  Meaning        known      and     described      as 
of  the  Changes       "love."    An  eminent  writer  on 

metaphysics  says:  "The  first 
awakening  of  love  in  true  and  gentle  natures  is 
a  psychological  moment  of  the  utmost  impor- 
tance; the  spiritual  life  has  not  unfrequently 


WHO  IS  INSANE?  Ill 


started  from  this  point."  But  so  various  are  the 
forms  of  this  expression  that  six  contemporary 
experts  of  insanity  give  the  following  defini- 
tions of  love,  as  described  in  current  works  of 
fiction,  viz.,  "emotive  delusion,"  "fixed  idea," 
"rudimentary  paranoia,"  "psychic  emotive  ob- 
session," psychic  neurasthenia,"  "episodic  symp- 
toms of  hereditary  degeneracy." 

Such  an  array  of  diverse  opinions  of  learned 
observers  proves  the  controlling  influence  of  the 
new  elements  which  enter  into  the  nervous  con- 
stitution during  adolescence.  A  high  authority 
says:  "From  whatever  side  or  symptom  we 
start,  we  trace  the  mental  peculiarities  of  ado- 
lescents to  the  aroused  and  active  affective 
nerve-centres."  How  true  was  the  remark  of  the 
unlearned  victim  of  insanity,  "We  are  all  built 
that  way !" 

It  is  not  surprising  that  adolescents  are  often 
not  only  popularly  believed  to  be  insane,  so  com- 
plete is  the  change  of  character  and  conduct,  but 
that  thousands  are  committed  to  asylums  in 
whom  the  first  impulses  of  love  are  misinter- 
preted as  acts  resulting  from  delusions,  illu- 
sions and  hallucinations.  Shakespeare  gives  ex- 
pression in  emphatic  language  to  the  popular 
opinion,  "Love  is  merely  a  madness,  and,  I  tell 
you,  deserves  as  well  a  dark  house  and  whip  as 
madmen  do."  Carlyle  writes  more  philosophic- 
ally, "Love  is  not  altogether  a  delirium,  yet  it 


112  WHO  IS  INSANE? 

has  many  points  in  common  therewith."  Plau- 
tus  says,  "It  is  good  to  be  moderately  sane  in 
love."  Browning,  Coleridge,  Tennyson  and  oth- 
er writers  might  be  quoted  to  the  same  effect, 
and  it  is  very  natural  that  they  should  regard 
love  as  a  species  of  insanity  from  the  standpoint 
of  its  vagaries. 

THIS  is  the  story  of  "one  who  never  told  her 
love."    Among  her  adolescent  boy  compan- 
ions was  one  for  whom  she  suddenly  con- 
ceived a  peculiar  attachment,  but  she  carefully 
concealed  her  feelings.     She  believed  that  he 
entertained  the  same  feelings 
Derangement       toward  her,  but  did  not  make 
from  Love  his  love  known.     One  day  he 

and  a  companion  went  out  on 
the  sea  in  a  small  sailing  craft  and  never  re- 
turned. She  at  once  fell  into  a  melancholy 
mood,  and  in  her  morbid  mental  state  gradually 
came  to  the  conclusion  that  her  friend  was  not 
lost  at  sea,  but  had  gone  to  some  remote  coun- 
try and  in  time  would  return  and  acknowledge 
his  love  for  her. 

She  continued  to  pursue  her  course  of  study 
of  art  and  finally  attained  considerable  repute 
as  an  artist.  The  belief  that  her  long  absent  lover 
would  return  became  more  and  more  a  fixed 
opinion  and  she  began  to  scrutinize  men  whom 
she  met  in  the  street  in  the  hope  that  she  would 


WHO  IS  INSANE?  113 

discover  him.  At  length  she  saw  a  young  man 
approaching,  who,  before  meeting  her,  passed 
to  the  other  side  of  the  street,  which  im- 
pressed her  with  the  behef  that  he  was  her 
friend,  considerably  changed  by  time.  She  fol- 
lowed him  and  succeeded  in  learning  his  name. 
It  was  not  the  name  of  her  friend,  but  she  con- 
cluded that  he  had  assumed  another  name  to 
escape  detection,  and  accordingly  wrote  him  a 
letter  full  of  endearing  terms,  urging  him  to  re- 
turn to  her  and  professing  her  undiminished 
love  for  him,  notwithstanding  his  wandering 
life  and  efforts  to  conceal  his  identity. 

With  a  detective  the  gentleman  thus  ad- 
dressed visited  the  writer  of  the  letter,  who 
frankly  told  them  of  her  long-lost  lover  and 
her  belief  that  he  was  the  man,  changed  both 
in  appearance  and  name.  She  was  promptly 
committed  to  an  asylum,  and  her  useful  life 
brought  to  an  abrupt  close. 

Sad  beyond  expression  is  the  mental  pertur- 
bation of  adolescents  who  are  the  victims  of 
concealed,  disappointed,  rejected,  or  despised 
love. 

"Of  all  pains,  the  greatest  pain. 
It  is  to  love,  but  love  in  vain." 

The  daily  papers  are  constantly  recording 
the  most  revolting  crimes,  suicidal  and  homi- 
cidal, committed  by  persons  distracted  by  dis- 


114  WHO  IS  INSANE? 


appointed  love,  or  frenzied  by  jealousy.  It  is 
not  surprising  that,  in  the  present  state  of  hu- 
man society  and  popular  ignorance  of  the  brain, 
its  anatomy  and  physiology,  on  which  all  men- 
tal operations  depend,  so  many  adolescents 
are  wrecked  at  this  most  impressionable  period 
of  their  lives.  By  the  community  they  are  ac- 
counted weak-minded,  frivolous,  and  are  made 
the  subjects  of  ridicule  and  even  contemptuous 
remarks,  though  they  are  passing  through  a  nat- 
ural physiological  process  which  is  preparing 
them  for  the  higher  and  more  responsible  du- 
ties of  life. 

THE  lesson  which  these  facts  impress  is  this. 
During  the  period  of  adolescence,  when  the 
integrity  of  the  nervous  system  trembles  in 
the  balance,  every  proper  effort  should  be  made 
to  create  such  associations  and  affiliations  of 

young  men  and  women  as 
Care  Required  will  lead  to  congenial  affini- 
in  Adolescence  ties.  The  ridicule  and  con- 
tempt with  which  "love-mak- 
ing" is  usually  treated  is  exceedingly  unwise, 
harmful  and  against  divine  appointment  and  a 
wise  public  policy.  The  judicious  and  discreet 
"match-maker"  is  a  most  useful  person  as  is 
witnessed  in  every  Jewish  community. 

"Are  you  married,  and  if  not,  why  not?"  was 
the   pertinent    inquiry    by    the   great    Chinese 


WHO  IS  INSANE?  115 


statesman  of  many  gentlemen  and  ladies  to 
whom  he  was  introduced  on  his  visit  to  this 
country.  Though  regarded  as  a  facetious  ques- 
tion and  indicative  of  ignorance  of  the  proprie- 
ties of  our  social  customs,  it  had  a  profound 
significance  when  interpreted  in  the  light  of  so- 
ciology. As  a  suitable  marriage  is  the  true  pre- 
ventive, or  remedial  measure,  of  a  vast  number 
of  physical,  mental  and  moral  ills  to  which  ado- 
lescents are  extremely  liable,  the  principles  un- 
derlying this  institution,  sanctioned  by  the  State 
and  solemnized  by  the  Church,  should  be  so  in- 
culcated by  education,  encouraged  by  society, 
and  sanctified  by  religion  that  marriage  would 
become  obligatory  on  every  adolescent,  except 
under  conditions  unfavorable  to  the  individual 
concerned,  or  against  public  policy. 

The  clear  indication  of  treatment  of  this,  as 
of  all  similar  intensive  actions  of  a  group  of 
nerve-cells,  is  the  effort  to  divert  the  affections 
from  the  unattainable  object,  which  originally 
interested  them,  and  to  concentrate  them  upon 
other  objects  of  as  absorbing  interest.  Physio- 
logically, this  treatment  involves  the  diversion 
of  nutrition  from  the  over-stimulated  nerve-cen- 
tres to  other  inactive  nerve-centres.  The  result 
would  be  the  gradual  shrinking  and  diminution 
of  the  function  of  the  excited  nerve-centres  and 
a  compensatory  activity  of  newly-aroused 
nerve-centres. 


116  WHO  IS  INSANE? 


How  can  this  be  accomplished?  First,  by 
removal  of,  or  from,  the  object  on  which  the 
affections  have  been  concentrated,  and  every 
thing  or  condition  which  suggests  such  object. 
Second,  by  concentration  of  the  thoughts  upon 
objects  of  interest  entirely  foreign  to  those 
which  originally  created  mental  disturbance. 
The  methods  of  meeting  these  indications  must 
be  adapted  to  the  peculiarities  of  the  individual 
and  the  conditions  in  each  case,  but  they  are 
innumerable  both  in  quantity  and  variety.  Ex- 
cept in  the  case  of  a  suicidal  or  homicidal  per- 
son, requiring  custodial  care  and  isolation  from 
the  activities  of  life,  the  world  abounds  with 
remedies,  preventive  and  remedial,  for  "ado- 
lescent insanity." 


VIII 
Mm-LiFE 


yiii 

Mid-Life 

HE  period  in  the  life  of  woman  be 
tween  the  years  of  twenty  and 
forty-five  and  in  the  life  of  man 
from  twenty-five  to  fifty,  may 
well  be  called  the  "Mid-Life"  of 
each  sex.    With  woman  it  is  the 
period  of  the  creation  of  the 
family,  and  with  man  it  is  the  period  of  build- 
ing and  sustaining  the  home.    With  both  it  is  a 
period  of  physical  and  mental 
The  Time  of     stress  and  strain;  of  testing  the 
Testing  inherited  tone  and  temper  of  ev- 

ery fibre  of  the  constitution;  of 
patient  endurance  of  manifold  ills;  of  meas- 
uring the  amount  and  kind  of  vital  forces — 
"Stock  in  Trade" — ^with  which  they  have  been 
endowed,  and  which  they  have  conserved  dur- 
ing the  treacherous  period  of  adolescence. 

Mid-life  of  a  woman  is  beset  with  far  more 
incidents  and  accidents,  which  tend  to  impair 
the  integrity  of  her  nervous  system,  than  is  the 
case  with  her  companion — man.  The  wonderful 

119 


120  WHO  IS  INSANE? 


mechanism  that  creates  a  living  soul  is  her  in- 
heritance. On  her  alone  fell  the  heavy  penalty, 
"in  sorrow  thou  shalt  bring  forth  children."  She 
alone  endures  the  pains  and  perils  of  maternity, 
and  she  alone — highly  favored —  experiences 
its  anticipations  and  its  ecstacies.  But  at  every 
stage  in  its  progress  her  nervous  system  is  in  a 
state  of  tension  requiring  continued  care  and  ef- 
fort to  maintain  its  normal  equilibrium. 

Occasionally,  alas,  when  the  crisis  seems  to 
have  been  safely  passed,  the  affective  faculties 
yield  to  the  long-continued  strain  and  the  old 
demoniacal  possession  recurs.  The  child,  the 
object  of  so  much  anticipated  joy,  is  rudely 
thrust  from  the  breast  that  is  giving  it  nourish- 
ment, and  all  of  the  maternal  instincts  of  affec- 
tion are  turned  to  hate  and  violence  against  the 
innocent  and  helpless  creation  of  her  own  blood 
and  body. 

Fortunately,  from  this  maniacal  state  the 
mother  usually  rallies  as  the  nerve  centers  of 
the  affections  recover  their  energy  and  cast  out 
the  demon  of  insanity.  But  frequently  we  meet 
the  wrecks  of  maternity  in  the  wards  of  the  asy- 
lums, and  sometimes  in  the  pitiable  condition 
of  dementia  in  which  the  sufferer  gratifies  the 
still  strong  maternal  instinct  by  carefully  nurs- 
ing a  "rag-baby." 

Another  feature  of  Mid-Life  in  woman,  tend- 
ing in  many  temperaments  to  mental  depres- 


WHO  IS  INSANE?  121 


sion  and  melancholia,  is  the  necessary  isolation 
which  her  duties  in  her  home  create.  Man  is  a 
"social,  gregarious  animal,"  says  the  philoso- 
pher, and  universal  experience  proves  the  truth 
of  the  proposition.  No  man  can  live  to  himself 
and  develop  all  that  is  possible  in  his  physiolog- 
ical constitution.  The  recluse,  the  ascetic,  the 
man  retired  from  business,  suffers  from  atrophy 
of  large,  unused  sections  of  the  brain,  which 
tends  to  mental  feebleness  and  imbecility. 


WE  conclude  that  the  decision  of  the  Council 
of  Creation,  "It  is  not  good  that  the  man 
should  be  alone,"  applies  with  equal  force  to  the 
woman,  who  was  made  "an  helpmeet  for  him." 

It  is  painful  to  see  so  many 

Woman's  Need       wives  of  farmers  in  the  asy- 

of  Companionship    lums  and  hospitals,  most  of 

whom  are  suffering  from 
forms  of  mental  depression.  Their  insanity  is 
usually  traceable  to  some  apparently  unimpor- 
tant event,  but  which  was  sufficient  to  unbal- 
ance a  nervous  system  already  weakened  by 
long  isolation  from  the  tonic  stimulant  of  social 
intercourse. 

The  measures  preventive  of  insanity  in  the 
"Mid-Life"  of  woman,  as  suggested  by  our  pre- 
vious studies,  are  simply  to  treat  the  human 
mother  with  the  same  care  with  which  we  treat 
the  brute  mother,  viz.,  protect  her  from  worry. 


122  WHO  IS  INSANE? 


fatigue,  and  undue  excitement  and  disturbance, 
supply  the  housewife  with  adequate  means  for 
social  enjoyments,  as  the  telephone,  magazines, 
a  library,  neighborhood  gatherings  for  enter- 
tainment or  cooperative  labor,  frequent  holi- 
days for  sight-seeing  and  travel.  It  will,  of 
course,  be  alleged  that  the  ordinary  farmer,  me- 
chanic, tradesman,  and  laborer,  cannot  afford 
the  time  nor  the  expense  for  indulgence  in  such 
luxuries;  but  there  is  no  force  in  such  an  ex- 
cuse when  we  contrast  the  benefits,  which  cer- 
tainly follow  the  adoption  of  some  or  all  of  the 
above  measures,  with  the  consequences  which 
attend  their  omission. 

The  Mid-life  of  the  man,  who  builds  and  sus- 
tains a  home  amid  the  uncertainties  of  modern 
competition  in  business,  is  constantly  subjected 
to  a  mental  and  physical  strain  that  ought,  ap- 
parently, to  terminate  in  a  nervous  break-down 
of  a  large  percentage.  Does  not  the  fact  that  so 
few  of  the  most  active  men  in  every  department 
of  business  become  insane,  prove  that  the  integ- 
rity of  the  brain-cells  depends,  like  other  tissues 
of  the  body,  largely  on  their  functional  activity? 
We  have  amply  demonstrated  that  the  cell  which 
ceases  to  perform  its  accustomed  function  must 
atrophy,  or  return  to  its  rudimentary  state.  With 
the  modern  business  man  there  is  no  cessation 
in  the  activity  of  the  brain-cells  devoted  to  his 
business  during  his  Mid-Life  period,  and  hence 


WHO  IS  INSANE?  123 


there  is  no  lapse  in  their  functions,  no  derange- 
ment, no  unsoundness,  no  insanity.  It  is 
when  conditions  interrupt  their  functioning  or 
arouse  other  nerve-centers  to  an  activity  which 
dominates  all  others,  that  the  normal  course  of 
thought  and  action  indicates  mental  aberration. 
How  can  the  business  man  prevent  insanity? 
Certainly  not  by  retiring  from  business,  but  by 
so  regulating  its  details  as  to  cause  the  least 
worry  or  anxiety.  The  business  man  who  has 
eight  hours  of  uninterrupted  dreamless  sleep  in 
the  twenty-four  hours  will  maintain  and  sustain 
— "other  things  being  equal" — a  sound  mind  in 
a  sound  body.  While,  therefore,  there  are  perils 
in  the  liabilities  to  great  disasters  in  business  of 
every  kind,  there  is  compensation  in  the  power 
of  resistance  which  the  nerve  elements  acquire 
by  constant  stimulation  to  activity  through  con- 
fact  with  opposing  and  contending  forces. 


IX 

Climacter 


IX 


Climacter 


LIMACTER  is  a  technical  word 
which  means  a  dangerous  or 
critical  period  of  life,  a  period 
in  which  some  great  change  is 
supposed  to  take  place  in  the 
human  constitution.  The  older 
writers  attached  much  impor- 
tance to  these  periods,  but  without  having  any 
rational  basis  for  their  opinions  other  than  im- 
perfect observations.  They  re- 
The  Time  duced  these  periods  to  a  system  of 
of  Crisis  seven  years  each.  They  regarded 
the  years  ending  the  third,  fifth, 
seventh,  and  ninth  periods  as  climacteric — dan- 
gerous, critical — because  a  great  change  takes 
place  in  the  constitution.  The  year  ending  the 
ninth  period  of  seven  years — the  sixty-third  year 
— was  called  the  grand  climacteric.  Though 
there  is  a  physiological  basis  for  some  of  these 
periods,  the  changes  in  the  constitution  which 
they  are  supposed  to  indicate  occur  so  variably 
as  regards  individuals  that  they  have  only  a  gen- 
eral significance. 

127 


128  WHO  IS  INSANE? 


The  true  import  of  the  "grand  climacter,"  in 
every  person  who  reaches  that  period,  is  the  be- 
ginning of  the  atrophy  or  wasting,  and  return  to 
their  dormant  condition,  of  the  nerve-centres  on 
which  depends  the  perpetuation  of  the  species. 
Great  as  was  the  change  in  the  nervous  consti- 
tution of  the  individual  when  these  centres  were 
aroused  to  activity  in  adolescence,  not  less  great 
and  disturbing  is  the  change  in  the  elements  of 
the  brain  structure  and  functions,  and  hence  in 
the  mental  and  physical  conditions  of  the  same 
person  when  their  activity  begins  to  decline. 

THE  rich  currents  of  nutritive  blood,  now 
diverted  to  other  sensitive  and  susceptible, 
but    formerly    passive    centres. 
New  Centers     may  so  change  the  mental  char- 
of  Activity       acteristics  and  conduct  of  the  in- 
dividual as  to  justify  the  verdict 
of  insanity.    Or,  again,  if  this  diversion  of  blood 
is  to  centres  long  active,  they  may  be  so  over- 
stimulated  that  the  equilibrium  is  unbalanced 
and  traits  of  conduct  and  character,  hitherto 
normal,  become  so  exaggerated  as  to  change  the 
mental  operations  in  a  very  marked  degree. 

The  immediate  effects  of  these  changes  is 
most  noticeable  in  the  mental  states  of  women. 
An  alienist  author  writes:  "The  affectiveness 
changes  in  its  object  and  greatest  intensity 
from  the  mate  to  the  progeny,  losing  its  imag- 


WHO  IS  INSANE?    ,  129 


inative  force,  its  fire,  and  its  impulsiveness;  po- 
etry and  love  tales  cease  to  have  the  power  to 
set  the  brain  on  fire;  action  of  all  kinds  ceases 
to  be  so  pleasurable  for  its  own  sake;  much  of 
the  go  is  out  of  the  person;  the  instinctive  feel- 
ing of  difference  of  sex  and  all  that  it  implies, 
which  has  been  all-pervading  before,  now  les- 
sens visibly;  the  subtile  interest  of  the  society  of 
the  other  sex  is  less  electric  and  overmastering; 
the  form  alters  and  the  expression  of  the  face 
changes;  the  blood-forming  and  blood-using 
processes  slacken  in  speed;  life  becomes  slower, 
mentally  and  physically." 

The  same  writer  traces  the  development  of 
insane  ideas  during  this  period  along  these 
lines:  There  is  a  loss  of  energizing  power,  bod- 
ily and  mentally;  failure  of  courage;  groundless 
fears,  which  are  at  first  known  to  be  groundless; 
annoyance  from  trivial  things;  dreamy,  broken 
sleep;  dread  of  appearing  in  company,  or  in 
public,  no  restful  feeling,  no  contentment  or 
happiness. 

These  conditions  may  pass  to  more  real  and 
continuous  depression;  the  morbid  fears  assume 
a  more  intense  character,  though  they  are  often 
still  indefinite;  the  person  is  sure  some  evil 
thing  is  going  to  happen  but  cannot  tell  what 
it  is  to  be;  self-control  is  often  lost,  but  more 
frequently  there  is  fear  that  it  will  be  lost.  There 
are  vague  impulses  towards  suicide,  sometimes 


130  WHO  IS  INSANE? 


towards  hurting  children  and  friends,  which 
add  to  the  terror  and  intensify  the  depression; 
a  conscious  loss  of  affection,  or,  rather,  a  loss 
of  the  pleasurable  feeling,  that  conscious  affec- 
tion for  the  members  of  the  family  gives,  is  a 
cause  of  the  greatest  distress. 

In  extreme  cases  suicidal  feelings  are  strong 
and  attempts  frequent,  but  the  very  loss  of 
courage  and  vigor  of  will  operates  against  any 
effectual  attempts  at  suicide;  hallucinations  of 
hearing  are  frequent.  Finally,  this  condition 
may  pass  into  acute  excited  melancholia  and 
exhaustion,  or  it  may  become  a  chronic,  shy  use- 
lessness  or  paralysis  of  power. 

A  lady  forty-five  years  of  age,  mother  of  sev- 
eral children,  began  to  be  depressed,  then  very 
irritable  and  fault-finding.  A  feature  of  her 
irritability  was  developed  towards  her  hus- 
band; she  could  neither  endure  his  presence, 
nor  his  absence;  she  drove  him  from  her  room 
with  violence  and  insulting  language,  and  then 
charged  him  with  neglect  while  he  was  absent 
and  begged  him  to  return,  only  to  renew  her 
violence  on  the  touch  of  his  lips,  though  insist- 
ing on  kissing  him.  She  was  committed  to  an 
asylum,  but  promptly  threw  herself  from  a  win- 
dow, receiving  a  profound  shock  and  a  broken 
leg,  followed  by  a  severe  hemorrhage.  Prompt 
recovery  from  her  insanity  resulted. 

The  remedy  in  this  case  was  severe,  but  it  was 


,WHO  IS  INSANE?  131 


a  repetition  of  the  method  of  treatment  followed 
by  the  old-time  practitioners,  who  believed  that 
nature  indicated  repeated  blood-letting  as  the 
proper  treatment  during  the  climacteric  period. 
It  was  also  held  by  the  ancients  that  a  severe 
shock  to  the  nervous  system  was  the  kind  of  di- 
version the  patient  required  to  restore  mental 
equilibrium — two  remedies  which  this  lady  re- 
ceived. 

In  a  rude  and  general  sense  these  indications 
of  treatment  have  a  physiological  basis 
and  are  correct,  and,  when  properly  met,  give 
a  measure  of  success,  as  in  the  case  given  in  il- 
lustration. The  course  of  blood-lettings,  so  gen- 
erally practiced  but  a  score  or  two  years  ago, 
are  rarely  required,  as  far  more  simple  and 
equally  effective  measures  may  be  employed. 

A  CULTIVATED  lady,  the  mother  of  a  fam- 
ily, had  been  devoted  to  the  care  of  her 
house  from  her  marriage  at  twenty.  Housekeep- 
ng  was  with  her  a  matter  of  absorbing  interest, 
even  to  the  minutest  detail.   She 
The  Effect  of    was  of  an  excitable  temperament 
Inactivity       and    any     disturbance     of    her 
household  arrangements  was  the 
source  of  great  annoyance.   At  the  age  of  forty- 
five  a  change  in  her  physical  and  mental  condi- 
tion was  noticed  by  her  friends.    In  family  con- 
sultation it  was  decided  that  she  was  suffering 
from  too  much  care  of  household  affairs,  and  it 


132  WHO  IS  INSANE? 


was  proposed  that  the  eldest  daughter  assume 
the  charge  of  the  home  and  that  the  mother 
should  be  completely  relieved  of  her  former  du- 
ties. 

Accordingly  the  daughter  began  to  assume  the 
position  of  mistress  and  the  mother  was  required 
to  spend  her  days  quietly  and  unoccupied  in  her 
room,  to  retire  early  and  rise  late,  and  avoid  ev- 
ery form  of  household  duty.  At  first  the  mother 
accepted  the  situation  and  seemed  pleased  with 
the  change,  but  soon  began  to  exhibit  a  train  of 
new  symptoms.  She  became  more  wakeful  than 
usual,  conplained  of  flashes  of  heat,  headaches, 
bad  dreams;  her  complexion  became  sallow, 
her  appetite  fickle.  Her  mental  condition 
changed;  she  was  more  easily  annoyed,  refused 
to  see  friends,  conversed  with  herself,  feared 
burglars  and  examined  every  door  and  window 
at  night.  As  time  passed  her  feebleness  and  de- 
pression increased,  suspicions  of  persecution  ap- 
peared, and,  later,  she  developed  delusions  of 
hearing  w^hich  took  the  form  of  suggestions  of 
suicide  and  homicide.  She  was  duly  examined 
by  expert  physicians,  adjudged  insane,  and 
committed  as  a  dangerous  lunatic. 

The  sequel  of  her  case  was  very  happy  and  in- 
structive. The  superintendent  of  the  asylum  to 
which  she  was  taken  was  a  learned  and  expe- 
rienced man  in  his  specialty,  and,  withal,  had 
sound  judgment  and  a  large  measure  of  good 


WHO  IS  INSANE?  133 

sense.  After  a  thorough  examination  of  all  the 
facts  in  her  history,  and  a  careful  study  by  prop- 
er tests  of  her  bodily  condition,  he  advised  that 
she  return  home  and  be  allowed  to  resume  her 
former  household  duties.  He  gave  specific  di- 
rections to  her  attending  physician  to  the  effect 
that  the  first  and  most  essential  feature  of  the 
treatment  was  occupation  of  her  thoughts  with 
her  life-long  duties;  second,  improvement  of  her 
digestion;  third,  bathing,  with  well  regulated 
massage;  fourth,  excursions  which  should  give 
the  greatest  amount  of  diversion. 

She  did  not  enter  the  asylum,  but  returned 
home,  and  the  treatment  recommended  was 
faithfully  followed.  The  result  was  most  fa- 
vorable; the  patient  readily  resumed  her  house- 
hold duties  and  at  once  ceased  to  complain;  the 
physician  corrected  errors  in  her  diet  so  that  her 
nutrition  rapidly  improved;  the  bathing  and 
massage  were  enjoyed  after  a  brief  trial,  and  the 
out-door  exercise  diverted  her  thoughts  to  nat- 
ural objects,  which  tend  powerfully  to  quiet  a 
mind  disturbed  by  insane  ideas. 

The  lessons  which  we  learn  from  a  study  of 
the  physiological  changes  of  the  nervous  system, 
and  the  consequent  mental  disturbances  at  the 
climacteric  periods,  are  so  closely  related  to  the 
final  decadence  of  all  of  the  tissues  of  the  body 
that  the  peculiarities  of  what  is  familiarly 
known  as  "old  age,"  or  the  post-climacteric  pe- 
riod, requires  our  study  in  this  connection. 


X 

Old  Age 


Old  Age 

LD  age,  the  period  of  decadence, 
physiologically  begins  with  the 
passing  of  the  climacter.  What 
is  its  significance?  In  the  av- 
erage person  it  means  the  de- 
cline of  all  of  the  physical 
forces  and  functional  activities. 
For  two-score  years  the  nervous  system  has 
been  aflame  with  passion,  fervor  and  ambition; 
the  bodily  temperature  has  been  at 
The  Time  fever  heat;  the  heart  has  throbbed 
of  Decline  with  tremendous  energy;  every  mus- 
cle has  been  keyed  up  to  its  utmost 
tension;  every  sense-organ  has  been  keenly 
alive  to  impressions.  Now  the  fires  begin  to 
slacken,  the  fever  declines,  the  heart  slows 
down,  the  muscles  relax,  the  senses  become  dull. 
Sadness,  like  a  malarial  chill,  creeps  along  the 
nerves.  The  long-active  nerve-centres,  now  un- 
used, shrink  and  undergo  loss  of  vitality;  the  ar- 
teries become  brittle  by  changing  to  bone,  or 
soft  and  weak  by  deposits  of  fat;  the  joints  stif- 

137 


138  WHO   IS   INSANE? 

fen  from  want  of  the  lubrication  that  comes  of 
constant  use;  the  senses — sight,  hearing,  smell, 
taste,  touch — decline  in  proportion  as  they  cease 
to  be  actively  employed. 

The  rush  of  business,  the  clash  of  rivalry,  the 
heat  of  contention  no  longer  stimulate  to  activ- 
ity, but  rather  increase  the  desire  for  quietude, 
repose,  retirement.  The  arm-chair  in  the  cozy 
corner,  the  smoking  cap,  the  dressing  gown  and 
easy  slippers,  meet  every  want.  Eating,  drink- 
ing, smoking,  sleeping  are  the  favorite  pastimes. 
The  body  becomes  over-laid  and  over-weighted 
with  fat,  and  every  organ — heart,  liver,  kidneys 
— is  clogged  with  waste. 

All  of  these  conditions  tend  inevitably  to  that 
degeneration  of  brain  tissues  which  terminates 
in  dementia,  or  paralysis.  The  approaches  of 
the  former,  says  an  author,  will  begin  in  slight 
failure  of  mind,  slight  change  of  character,  and 
slight  loss  of  muscular  strength  and  accuracy  of 
muscular  adjustment,  proceeding,  sometimes 
faster  and  sometimes  slower,  with  occasional 
temporary  improvement,  to  complete  demen- 
tia, and  helplessness.  Paralysis,  due  to  effusion 
of  blood  from  a  ruptured  artery  of  the  brain, 
will,  on  its  first  occurrence,  be  slight,  as  the  ar- 
tery is  small;  the  second  stroke  will  be  more  se- 
vere, as  the  artery  is  larger;  and  the  third  will 
probably  be  fatal  for  the  same  cause.  Truly 
"we  are  all  built  that  way." 


WHO  IS  INSANE?  139 


BUT  is  there  no  obverse  side  of  this  picture? 
Have  we  no  power  of  retarding,  if  not  pre- 
venting, the  degeneracies  and  consequent  insani- 
ties of  old  age?    A  very  pertinent  answer  was 

given  by  a  nonagenarian  phy- 
Can  We  sician  to  one  who  inquired  by 

Remain  Young?  what  mode  of  living  he  main- 
tained a  high  degree  of  health 
at  such  a  great  age:  "I  have  always  kept  my 
brain  and  stomach  in  good  repair  and  very 
busy."  This  answer  was  characterized  by  good 
sense  and  it  embodied  two  physiological  truths 
very  compactly  stated.  The  brain,  the  source  of 
vital  energy,  and  the  stomach,  the  source  of  nu- 
trition, maintained  in  a  state  of  functional  ac- 
tivity, are  capable  of  retarding  the  decadence 
of  old  age. 

An  ingenious  physiologist  explains  the  phe- 
nomena of  old  age  in  terms  that  give  point  to 
the  nonagenarian's  rule  of  living,  as  follows: 
"A  healthy,  well  nourished  human  body  is  main- 
tained in  that  condition  only  when  each  cell- 
structure  is  performing  its  normal  or  physio- 
logical function.  In  proportion  as  that  func- 
tion diminishes,  the  cell  shrinks  and  wastes. 
The  powerful  arm  of  the  blacksmith  soon  with- 
ers to  helplessness  when  placed  in  a  sling,  ow- 
ing to  the  diminution  of  the  blood-supply  to  its 
nerve  and  muscle  cells,  but  if  the  normal  use  of 
the  arm  is  restored  these  cells  soon  resume  their 
activity  by  the  increased  nutrition." 


140  WHO   IS   INSANE? 


Bandage  the  eyes,  and  the  nerve  and  nerve- 
centre  of  sight  will  waste  until  blindness  en- 
sues. Restore  the  light,  the  natural  stimulus 
of  the  nerve-centre  of  sight,  and  its  cells  at  once 
begin  to  resume  their  activity,  and  through  the 
increased  flow  of  blood  which  results,  they 
enlarge  to  their  natural  size  and  their  functions 
are  fully  restored. 

A  surgeon  of  great  eminence  determined  to 
retire  to  the  country  at  the  age  of  sixty  and  en- 
joy the  remainder  of  his  life  in  the  quiet  and 
leisure  of  rural  scenery.  He  had  been  very  suc- 
cessful in  his  profession,  to  which  he  had  de- 
voted every  energy  of  body  and  mind  for  a  gen- 
eration. He  was  a  popular  teacher  in  the  med- 
ical college,  an  author  of  great  repute,  and  took 
rank  in  society  among  the  first  citizens.  He  pur- 
chased a  large  and  well  appointed  estate  and 
with  much  ceremony  and  publicity  retired 
from  business  and  entered  upon  his  new  mode 
of  living. 

All  the  conditions  of  his  daily  life  were 
changed.  The  very  stillness  of  the  country  pre- 
vented sound  and  refreshing  sleep.  He  arose 
in  the  morning,  depressed  by  the  thought  that 
no  patients  would  call  and  at  a  loss  how  he 
could  employ  his  time.  Walking  soon  became 
irksome,  riding  tedious  and  very  tiresome,  the 
affairs  of  his  estate  were  uninteresting  because 
the  details  were  unfamiliar.    He  became  irrita- 


WHO  IS  INSANE?  141 


ble,  morose  and  melancholic;  delusions  of  con- 
spiracies against  his  person  and  property  fol- 
lowed, and  scarcely  a  year  elapsed  before  he 
was  pronounced  of  unsound  mind,  and  unable 
to  manage  his  estate. 

His  son-in-law,  also  a  surgeon  of  repute,  be- 
came his  guardian.  Believing  that  the  break- 
down of  the  father-in-law  was  due  to  an  ab- 
rupt change  of  occupation,  the  young  surgeon 
restored  him  to  his  former  office.  His  old  pa- 
tients returned,  and  scarcely  a  week  passed  be- 
fore the  senior  surgeon  was  himself  again. 

THE  plain,  practical  lesson,  which  this,  and 
thousands  of  similar  cases,  teach,  empha- 
sizes  the   physiological   truth   that   those   who 
reach  the  border-land  of  old  age  and  begin  to 
suffer  the  sadness  incident  to 
Remain  Active     the    depression    of    the    vital 
in  Old  Age         forces  should  strive  to  keep  ev- 
ery organ  of  the  body  attuned 
to  its  normal  functional  activity.     Retirement 
from  business  at  this  period,  to  enjoy  the  fruits 
of  a  life  of  toil,  is  to  turn  one's  face  towards  the 
cemetery  to  which  he  will  hasten  with  ever 
quickening  step. 

The  asylums  number  among  their  insane  in- 
mates aged,  helpless  dements  and  imbeciles,  by 
the  score,  who  could  have  enjoyed  a  vigorous 
old  age  had  they  not  passively  yielded  to  the  de- 


142  WHO   IS   INSANE? 

pressive  influences  which  attend  the  abatement 
of  the  vital  forces  at  sixty.  The  brain,  the 
source  of  vitality,  and  the  stomach,  the  source 
of  nutrition,  maintained  in  good  repair  and 
healthy  activity  at  oinety,  are  rational  philoso- 
phy and  sound  physiology.  No  one  can  grow 
old  or  be  old  while  these  two  organs  are  in  good 
condition. 

Victor  Hugo  stated  that  when  he  reached  the 
age  of  sixty  years  he  was  seized  with  a  sadness 
which  made  him  very  miserable,  but  he  pressed 
forward  with  his  daily  tasks  with  unabated 
vigor.  At  seventy  he  recovered  all  of  his  for- 
mer buoyancy  of  spirits  and  life,  and  was  as  full 
of  brightness  and  happiness  as  in  his  boyhood. 
Reflecting  upon  this  peculiar  change  of  feeling 
and  outlook  upon  life,  he  came  to  the  conclu- 
sion that  at  sixty  he  entered  upon  the  old  age 
of  youth,  but  at  seventy  he  entered  upon  the 
youth  of  old  age. 

The  experience  of  the  great  French  writer, 
who  continued  activity  at  his  life-work  far  be- 
yond the  allotted  period  of  life,  should  impress 
the  lesson  that  the  best  protection  against  the 
dementias  and  imbecilities  of  old  age  is  the 
maintenance  of  the  healthy  functions  of  the 
brain  and  stomach.  We  often  hear  of  per- 
sons who  grow  old  gracefully.  They  are  the 
energetic  class,  who  never  retire  from  the  activ- 
ities of  life  in  one  form  or  another.    With  them 


WHO  IS  INSANE?  143 


there  is  no  climacter,  or  change  of  life,  but  the 
current  runs  smoothly  on,  ever  widening,  ever 
deepening,  until  it  is  lost  in  the  ocean  of  eter- 
nity. 

Whittier  was  several  years  the  senior  of 
Holmes,  and  when  the  former  reached  the  age 
of  eighty,  the  latter,  in  a  witty  poem,  inquired 
as  to  the  outlook  from  that  dizzy  height.  Whit- 
tier replied  in  the  same  strain,  giving  a  glowing 
account  of  the  scenery  from  that  view-point 
and  urged  Holmes  to  hasten  up  the  steep  as- 
cent and  enjoy  with  him  the  glorious  prospect, 
assuring  his  friend  that  there  would  be  no  more 
climbing  as  the  path,  radiant  with  the  dawn  of 
the  life  beyond,  had  a  gentle  descent  to  the  river. 

We  conclude,  therefore,  that,  although  "we 
are  built  that  way,"  we  may  escape  the  insani- 
ties of  childhood,  adolescence,  climacter,  and 
old  age,  if  we  strictly  comply  with  the  physio- 
logical laws  governing  the  evolution  of  the  body 
during  these  periods. 

By  taking  heed  to  our  ways  we  may  peace- 
fully and  happily  pass  through  the  sixties;  at 
three  score  and  ten,  realize  the  joys  of  a  re- 
newal of  life  with  Victor  Hugo;  at  four  score 
view  the  future  with  the  serenity  of  Whittier; 
and  if  we  keep  the  brain  and  stomach  busy,  we 
may  pass,  with  the  nonagenarian  physician, 
into  the  nineties;  and  thence,  by  Grace,  with  the 
last  words  of  Sir  Henry  Irving  on  our  lips :  "Into 
Thy  Hands,  0  Lord." 


XI 

The  Prevention  of  Insanity 


XI 

The  Prevention  of  Insanity 

E  conclude,  therefore,  that  "we 
are  built  that  way,"   and  but 
for     certain     conservative     or 
inhibitory   forces,   inherent   in 
the  constitution  of  the  brain- 
cells,     we     should    be     liable 
at  any  moment  to  become  so 
"deranged,"  "strange,"  "peculiar,"  as  to  be  ad- 
judged insane.    It  is  only  necessary,  indeed,  that 
a  group  of  cells  should  become 
The  Liability    so  disturbed  in  their  operations 
to  Insanity      that    they    control    the    person's 
mentality,  to  raise  the  question 
of  sanity.     This  may  happen  on  the  instant, 
when  some  exciting  cause,  to  which  the  cells  are 
intensely    susceptible,    overwhelms    the    brain 
with  its  disturbing  force.     Generally,  however, 
the  change  is  slow  and  often  very  insidious,  and 
may  not  be  detected  for  a  considerable  period. 
To  discover  the  first  departure  from  the  path 
of  normality,  and  the  inducing  cause,  may  be 
a  very  simple  or  a  very  difficult  act.    In  either 

147 


148  WHO   IS   INSANE? 


case  the  first  aberrations  are  frequently  lim- 
ited to  a  single,  and,  perhaps,  obscure  function 
of  the  brain.  Gradually  other  affiliated  nerve- 
cells  become  involved,  and,  finally,  the  mental 
expressions  show  that  large  sections  of  the 
brain  have  become  tainted  with  the  original  in- 
fection. Shakespeare  traces  the  progress  of  the 
insane  ideas  thus ; 

"And  he  repulsed  (a  short  tale  to  make). 
Fell  into  a  sadness,  then  into  a  fast; 
Thence  to  a  watch;  thence  into  a  weakness; 
Thence  into  a  lightness ;  and,  by  this  declension, 
Into  the  madness  whereon  he  now  raves." 

HOW  the  harmony  of  functions  of  the  brain- 
cells  may  thus  be  disturbed  by  natural  con- 
ditions in  the  life  of  every  one,  what  are  the 
causes  of  such  disturbance,  and  by  what  signs 

and   symptoms    they   may   be 

The  Prevention    recognized  at  the  earliest  pos- 

of  Insanity         sible  moment,  are  questions  of 

immense  and  pressing  impor- 
tance to  parents,  teachers  and  individuals.  If 
these  questions  were  affirmatively  answered,  so 
as  to  be  thoroughly  understood  by  the  general 
public,  such  preventive  measures  could  be 
adopted  in  the  home-training  of  children,  in  the 
education  of  youths,  and  in  the  personal  living 
and  conduct  of  the  masses  of  the  people,  that 


WHO   IS   INSANE?  149 

our  asylums  would  be  depopulated  by  depriving 
them  of  fresh  recruits. 

The  parent  would  detect  in  the  evolution  of 
the  physical  constitution  of  the  child  the  first 
evidences  of  an  abnormal  development  of  any 
given  class  of  nerve-cells,  and  would  quietly,  but 
promptly,  adopt  proper  measures  to  secure  their 
repression.  The  instructor  could  not  fail  to  dis- 
cover and  appreciate  the  most  subtle  mental  pe- 
culiarities of  his  pupils,  and,  with  the  abundant 
means  at  his  command,  he  could  effectually 
counteract  their  incipient  tendencies.  And, 
finally,  each  person  could  intelligently  interpret 
the  true  significance  of  any  and  every  passion, 
propensity,  habit,  thought,  emotion  which  in- 
fluenced or  controlled  his  acts. 


XII 


The  Susceptibility  of  the  Insane  to  Curative 

Measures 


XII 


The  Susceptibility  of  the  Insane  to  Curative 

Measures 


HILE  the  extreme  sensitiveness 
of  the  brain-cell  to  impressions, 
both  from  external  objects 
through  the  medium  of  the  five 
sense-centres,  and  from  dele- 
terious substances  circulating 
in  the  blood  (auto-intoxica- 
tion), tend  powerfully  to  cause  deranged  men- 
tal action,  the  same  condition  is  fortunately 

very  favorable  to  its 


Brain-cell  Sensitiveness 
Favorable  to  Cure 


recovery.  We  are 
often  surprised  at  the 
slight  and  unimpor- 
tant circumstance  or  occurrence  that  so  dis- 
turbed the  equilibrium  of  the  brain  as  to 
require  the  commitment  of  a  person  to  an 
asylum,  and,  quite  as  frequently,  we  are  not  less 
surprised  at  the  simple  and  unimportant  inci- 
dents which  often  change  the  mental  operations 
of  the  insane  and  restore  their  sanity,  or  so  far 
relieve  them  of  any  disturbing  or  dangerous 

153 


154  WHO   IS   INSANE? 


tendencies  that  they  may  no  longer  require  cus- 
todial care.  The  following  cases  came  under 
observation : 

THIS  incident  occurred  in  the  life  of  a  dis- 
tinguished public  man  and  famous  orator, 
who  became  melancholy  owing  to  an  incident 
reflecting  upon  his  character.  He  finally  refused 
food,  was  wakeful  and  restless,  and  began  to 
wander  from  home.  Commitment  to  an  asylum 
followed.  On  entering  he  was  greatly  emaciated, 

talked  incoherently  about 
Cured  by  a  Bowl       the    conspiracy   formed   to 

of  Hot  Soup  ruin   him,    slept   little,   re- 

sented every  effort  to  con- 
trol his  movements,  and  finally  became  violent 
at  times.  Worry  and  consequent  insomnia  and 
inanition  had  exhausted  his  brain-cells,  and 
without  proper  care  dementia  would  have  re- 
sulted from  the  inevitable  atrophy  of  these  cells, 
from  which  he  would  never  have  recovered  un- 
der the  ordinary  routine  treatment  of  the  asy- 
lum. 

"I  protest!"  said  the  patient  as  he  arose  in  bed 
and  with  much  deliberation  drank  the  bowl  of 
hot,  rich  soup.  The  asylum  physician  had  care- 
fully examined  him  on  admission  and  con- 
cluded that  he  was  suffering  from  exhaustion 
due  to  want  of  proper  nourishment.  Accord- 
ingly, he  had  a  bowl  of  nourishing  soup  pre- 


WHO  IS   INSANE?  155 

pared  and  brought  to  the  bedside  and  the  pa- 
tient was  directed  to  take  it.  He  promptly  and 
with  great  emphasis  declared  he  would  not 
under  any  circumstances.  On  the  failure  of  re- 
peated efforts  to  persuade  him  to  drink  the 
soup,  the  physician  assumed  an  appearance  of 
determination  to  compel  him  to  obey. 

He  ordered  an  attendant  to  bring  a  stomach 
pump  and  an  assistant.  On  their  arrival  the 
superintendent,  holding  his  watch  in  his  hand, 
looked  sternly  into  the  face  of  the  patient,  and 
said:  "I  will  give  you  just  five  minutes  to 
drink  the  soup,  and  if  you  do  not  I  shall  pass 
this  tube  into  your  stomach  and  pump  the  soup 
into  it."  The  physician  then  called,  "One  min- 
ute! two  minutes!  three  minutes!  four  min- 
utes!" when  the  patient  arose,  and,  taking  the 
bowl  in  both  hands,  said  in  a  dramatic  manner, 
"I  protest!"  then  drank  the  liquid. 

The  effect  was  as  anticipated.  After  some 
excitement  sleep  ensued.  This  was  the  firsf 
nourishing  food  and  refreshing  sleep  that  he 
had  had  in  many  months.  He  awoke  after  sev- 
eral hours  and  realized  his  condition.  His  re- 
covery was  rapid  and  complete,  and  he  contin- 
ued of  sound  mind  until  his  death  many  years 
later,  of  an  acute  disease. 


B 


ELIEF  that  he  was  immune  against  arsenic 
led  to  the  discharge  of  a  paranoiac  as  recov- 


156  WHO   IS   mSANE? 


ered.  He  was  an  old  man  very  much  emaciated 
and  feeble,  who  begged  piteously  to  be  dis- 
charged from  the  asylum.  His 
Cured  by  a  chief  complaint  was  that  arsenic 
Suggestion  was  put  in  his  food  and  that  he 
was  suffering  for  the  want  of 
proper  nourishment,  which  was  evident  from 
his  appearance.  As  he  said  he  could  show  me 
the  arsenic  in  his  food,  I  visited  his  table  at  the 
dinner  hour  and  he  pointed  with  great  excite- 
ment to  a  greenish  tint  on  the  fried  eggs,  and 
declared  that  it  was  arsenic.  After  dinner  I  had 
an  interview  with  him.  "What  would  you  do  if 
you  had  such  food  regularly  given  you?"  he  in- 
quired. "Eat  it,"  was  my  reply.  "What!  allow 
yourself  to  be  killed  by  these  conspirators?  Not 
much!"  he  said.  I  assured  him  that  arsenic  was 
not  poisonous  in  small  doses,  such  as  appeared 
on  his  food;  that  a  great  many  ladies  took  it  to 
improve  their  complexion;  that  some  persons 
are  immune  against  the  effects  of  poisons;  that 
he  appeared  to  be  one  of  that  kind;  that  it  was 
well  worth  the  risk  of  a  trial,  for  if  he  proved  to 
be  immune,  and  ate  his  meals  regularly,  never 
alluding  to  poisons  again,  he  would  soon  be  dis- 
charged; but  that  if  he  persisted  in  refusing  his 
food,  because  it  was  poisoned,  he  would  never 
leave  the  asylum  alive. 
He  was  greatly  impressed  with  the  statement 


WHO   IS   INSANE?  157 

that  a  person  could  be  immune  against  such  a 
poison  as  arsenic.  He  hesitated  some  time  to 
make  the  trial  but  at  length  he  yielded,  on  my 
assurance  that  he  was  undoubtedly  immune 
and  that  he  would  secure  his  discharge  if  he  ate 
regularly  and  never  again  mentioned  the  word 
poison. 

On  visiting  this  asylum  several  months  later 
I  found  this  patient  at  work  in  the  "Cook 
House."  He  was  bright  and  cheerful  and  his 
face  shone  with  fatness.  He  had  found  that  he 
was  immune  against  arsenic,  ate  all  his  food 
with  a  relish  and  was  enjoying  excellent  health. 

On  parting  with  him  he  cautioned  me  not  to 
mention  the  word  "poison"  to  the  Superintend- 
ent, as  the  latter  had  promised  him  his  dis- 
charge on  the  following  Monday  and  he  never 
wished  that  word  used  again  for  fear  it  would 
lead  to  his  detention.  Approaching  me  cau- 
tiously and  whispering  in  my  ear  he  said, 
"Since  I  came  to  the  Cook  House  I  have  learned 
just  how  they  do  it,  for  I  see  them  put  the  ar- 
senic in  the  food."  Nevertheless  his  belief  that 
he  was  immune  against  arsenic  led  to  the  dis- 
charge of  this  paranoiac  as  recovered. 


ANIGHT  spent  with  the  insane  effectually 
cured  an  incipient  case.    The  patient  was  a 
young  man  who  gradually  exhibited  symptoms 


158  WHO   IS   INSANE? 

of  derangement,  and  finally  became  so  dis- 
turbed that  his  family  were 
Cured  by  a    alarmed.    By  the  advice  of  the  f  am- 

Shock  ily  physician  he  was  taken  to  the 
"Insane  Pavilion"  at  Bellevue  Hos- 
pital, New  York.  He  passed  a  sleepless  night  ow- 
ing to  the  disturbance  of  his  companions.  In  the 
morning  he  begged  to  be  taken  home  and  prom- 
ised never  to  repeat  his  previous  conduct.  He 
declared  that  he  was  so  shocked  at  what  he  saw 
that  he  began  to  think,  "Is  this  what  I  am  com- 
ing to?  I  will  change  my  life  here  and  now." 
He  was  able  to  control  himself  thereafter,  under 
the  influence  of  that  night's  experience,  and  re- 
mained sane  during  his  lifetime. 

"Can  a  paretic — a  person  suffering  from 
'general  paralysis' — recover?"  was  an  inquiry 
made  of  a  superintendent  distinguished  as  an 
accurate  diagnostician.  He  replied:  "  I  was 
formerly  of  the  opinion  that  paresis  was  an  ab- 
solutely fatal  disease,  but  a  case  under  my  ob- 
servation unsettled  my  belief  in  its  incura- 
bility. He  then  related  in  substance  the  follow- 
ing particulars: 

A  man  was  admitted  to  this  asylum  whose 
history  gave  a  complete  clinical  record  of  pare- 
sis. His  disease  progressed  as  a  typical  case  of 
that  trouble  until  it  seemed  to  have  reached  its 
final  stage,  and  a  fatal  convulsion  was  antici- 
pated at  any  time.    The  patient's  wife  was  then 


WHO   IS   INSANE?  159 

notified  of  his  condition  and  she  visited  him  for 
the  purpose  of  removing  him  to  his  home  in  ful- 
filment of  a  promise  she  had  made  him,  when 
he  consented  to  enter  the  asylum,  that  she 
would  never  allow  him  to  die  elsewhere  than  in 
his  own  home. 

She  was  informed  that  it  would  be  very  un- 
wise to  remove  him,  as  he  could  not  possibly  en- 
dure the  journey  of  twenty  miles.  She  insisted, 
however,  even  if  he  should  die  on  the  way.  Con- 
sent was  finally  given  on  her  assuming  all  re- 
sponsibility, and  every  effort  was  made  to  ren- 
der his  transportation  comfortable  and  to  pro- 
vide her  with  the  means  of  meeting  any  and 
every  emergency. 

DURING  the  long  journey  he  remained  in  a 
semi-conscious  condition,  occasionally  tak- 
ing such  food  and  stimulants  as  she  gave  him. 
On  approaching  his  home,  his  house  suddenly 

came  into  view  from  a  hill-top. 

Cured  by  a       when   he   became   excited   and 

View  of  Home    attempted    to    speak    and    rise 

from  his  seat.  On  her  inquiry 
as  to  the  cause  of  his  excitement  he  muttered, 
with, great  effort,  "Is  not  that  my  house?"  From 
that  moment  he  began  to  recover.  The  superin- 
tendent, one  of  the  most  distinguished  in  the 
country,  added:  "To-day  he  ranks  as  the  best 
farmer  in  his  county,  as  he  takes  the  largest 
number  of  prizes  at  the  annual  fairs." 


160  WHO   IS   INSANE? 


This  case  is  not  related  to  illustrate  the  possi- 
ble curability  of  paresis  at  an  extreme  stage  of 
its  progress,  but  rather  to  show  the  effect  of 
arousing  to  activity  nerve-centres,  long  dor- 
mant, by  change  of  environment.  Though  there 
may  have  been  an  error  of  diagnosis,  the  fact 
remains  that  this  man  was  believed  to  be  in  the 
last  stage  of  a  fatal  disease  and  that  his  recov- 
ery dated  from  a  new  stimulus  to  his  brain  by  a 
view  of  his  house.  The  lesson  which  we  learn 
is  that  the  cases  of  insanity  apparently  most 
hopeless  should  not  be  abandoned.  ^ 

THIS  is  a  Lunatic  Asylum  and  not  a  Sanita- 
rium, which  they  said  I  was  to  come  to.  I 
want  to  go  home.  Do  you  know  how  to  get  out  of 
this  place?"    This  was  the  greeting  which  the 
visitor  received  on  entering  the 
Cured  by        disturbed   ward   of   an   Asylum. 
Good  Advice     The  patient,  who  had  just  been 
admitted,  was  a  young  man,  in- 
tensely excited,  much  emaciated,  with  hair  dis- 
heveled, eyes  protruding,  arms  thrown  wildly 
about,  voice  hoarse  from  screaming.     He  was 
the  picture  of  one  suffering  from  acute  mania, 
for  which  he  was  admitted. 

As  he  rushed  up  to  the  visitor  and  asked  the 
above  question  the  latter  was  seized  with  an 
impulse  to  attempt  to  quiet  him,  and  placing 
his  hand  on  his  shoulder  in  a  familiar  manner 


WHO  IS   mSANE?  161 

whispered  in  his  ear,  "Yes,  I  know  how  to  get 
out  of  here,  but  I  should  not  dare  tell  you  as 
you  speak  so  loud  that  the  attendant  might  learn 
what  I  had  done  and  would  have  me  locked  up." 
He  immediately  became  quiet  and  begged  my 
pardon  in  a  whisper,  declaring  that  he  would 
keep  the  secret  if  I  would  help  him  escape. 

Taking  him  into  a  private  room  I  expressed 
my  doubts  as  to  his  being  a  proper  person  to 
whom  I  should  reveal  the  secret;  that  he  must 
first  give  me  an  accurate  account  of  his  life  and 
all  of  the  circumstances  which  led  to  his  being 
committed.  He  related  a  series  of  business 
transactions  which  had  greatly  disturbed  him, 
culminating  in  an  incident  which  led  him  to  be- 
lieve that  his  wife  was  unfaithful  to  him  through 
the  influence  of  the  Catholic  priest.  This  event 
was  the  climax  of  his  efforts  to  control  his  acts 
and  for  a  fortnight,  or  until  brought  to  the  Asy- 
lum, he  said.  "I  painted  the  village  black  as 
h — 1."  The  last  shock  to  his  nerve-centres,  ex- 
hausted from  want  of  sleep  and  nutrition,  was 
to  find  that  he  had  been  deceived  by  his  friends 
by  being  placed  in  a  Lunatic  Asylum  instead  of 
a  Sanitarium. 

A  few  words  of  comment  on  his  nervous  con- 
dition, an  explanation  of  the  events  which  so 
disturbed  him,  and  an  emphatic  denial  of  the 
construction  which  he  put  upon  his  wife's  con- 
duct, and  the  added  charge  that  he  had  evi- 


162  WHO  IS  insane' 


dently  treated  her  shamefully  and  cruelly,  broke 
him  completely  down.  With  tears  and  sobs  he 
acknowledged  his  mistakes  and  asserted  with 
great  earnestness,  "I  see  that  I  have  been  a  d — d 
fool  from  the  start." 

Promising  to  strictly  follow  advice,  he  was 
directed  in  detail  how  to  conduct  himself,  viz., 
be  very  quiet,  very  clean  and  well  dressed;  keep 
his  room  in  perfect  order;  constantly  assist  the 
attendant  in  all  of  his  ward  work;  endeavor  to 
preserve  order  among  the  patients  by  his  exam- 
ple and  kindly  attention  to  their  wants, 
show  no  irritation  or  resentment  in  his 
treatment  by  patients.  He  was  assured  that  he 
would  be  discharged  within  a  week  if  he  fol- 
lowed strictly  the  rules  of  conduct  prescribed. 

On  visiting  the  Asylum  two  months  after  this 
interview  it  was  found  that  he  was  discharged, 
"not  insane,"  on  the  fourth  day  after  admission. 
On  calling  the  attention  of  the  Superintendent 
to  his  case  he  remarked  that  the  physician  who 
committed  him  made  a  very  grave  mistake,  for 
though  much  disturbed  on  entering  the  Asylum 
he  soon  quieted  down  and  proved  to  be  the  best 
worker  and  most  useful  man  about  the  place. 
Frequent  inquiries  in  regard  to  him  after  his  re- 
turn home  showed  that  he  had  continued  per- 
fectly well. 

What  saved  this  man  from  becoming  a  per- 
manent resident  of  the  Asylum?    He  entered  a 


WHO   IS   INSANE?  163 

complete  "nervous  wreck"  and  was  in  a  frenzy 
on  finding  that  he  was  in  a  "Lunatic  Asylum" 
instead  of  a  Sanitarium;  he  was  assigned  to  the 
"disturbed  ward"  where  fifty  or  more  inmates 
similarly  affected  terrified  him  with  their  rav- 
ings; no  officer  ir?id  inquired  into  the  peculiari- 
ties of  his  case  and  kindly  advised  and  encour- 
aged him,  nor  in  the  ordinary  course  of  treat- 
ment was  he  likely  to  receive  such  attentions  at 
any  time.  Undoubtedly  the  quiet,  friendly  in- 
quiry into  the  events  which  led  to  his  commit- 
ment, an  explanation  of  their  significance  with 
impressive  firmness,  and  advice  as  to  his  con- 
duct to  secure  prompt  release,  led  to  his  imme- 
diate discharge,  saved  the  State  from  the  ex- 
pense of  his  support  for  fifteen  years,  the  aver- 
age life-time  of  inmates  of  Asylums;  and,  final- 
ly, returned  to  his  home  in  sound  mind  its  sup- 
porter and  protector. 

INSANE  Women  Go  Shopping,"  is  the  start- 
ling headline  of  a  daily  paper.  It  appears 
that  the  Superintendent  of  an  Insane  Asylum 
was  impressed  with  the  belief  that  diver- 
sion would  aid  in  curing  the  insane,  and  put  his 
theory  to  the  test  by  allowing  sixty  women  pa- 
tients suffering  with  milder  forms  of  mental 
disturbance  to  visit  a  department  store.  The 
first  party  consisted  of  twenty  patients  and  is 
thus  described. 

"Two  attendants  were  in  charge  of  the  shop- 
pers. Their  uniforms  were  left  behind  and  they 


164  WHO   IS   INSANE? 

abandoned  as  far  as  possible  all  tokens  of  au- 
thority. 

"Mingling  in  the  crowds  down  town  and  in 
the  big  stores,  the  patients  and  attendants  were 
swallowed  among  thousands  of  other  women 
bent  on  the  same  mission.  The  patients  pur- 
chased with  a  keen  regard  to  appearance  and 
value,  just  as  their  normal  sisters  were  buying 
all  about  them.  Apparently  the  saleswomen 
noted  nothing  unusual  in  their  demeanor. 

"Laughing,  chatting,  haggling  with  the  sales- 
women, they  spent  their  time  and  money  all  too 
soon.  They  were  loath  to  return  when  dark- 
ness found  them  still  at  the  counters  buying 
what  they  could  and  admiring  the  much  greater 
treasure  of  what  they  could  not  purchase. 
Above  all,  they  were  impressed  with  the  novelty 
of  a  moving  stairway  in  a  big  department  store. 
Some,  timid  at  first,  became  frequent  passen- 
gers on  this  stairway  and  left  the  store  grudg- 
ingly." 

The  Superintendent  says  of  the  experiment: 
"Such  recreation  as  that  afforded  by  a  day  in  the 
stores  is  a  valuable  part  of  the  treatment  for  the 
insane.  Just  as  normal  persons  are  better  merry 
than  moody,  so  are  my  charges  improved  by 
anything  that  pleasantly  occupies  their  minds 
while  at  the  same  time  not  exciting  their 
nerves." 


WHO   IS   INSANE?  165 

The  most  impressive  lesson  which  my  expe- 
riences among  the  insane  taught  was  the 
vast  importance  of  a  thorough  examination  of 
the  patient  by  a  competent  person  at  the  earUest 

possible  period.  Thou- 
Importance  of  sands  are  admitted  to 

an  Early  Examination  the  institution,  classi- 
fied and  assigned  to 
wards,  merely  on  the  statement  of  the  certifying 
physician  in  the  commitment  papers  which  ac- 
company the  patient.  In  the  wards  they  are 
subject  only  to  the  general  observation  of  the  at- 
tendant, in  connection  with  fifty  or  more  who 
constantly  require  his  care. 

Long  periods  often  elapse  before  a  case  at- 
tracts the  special  attention  of  the  medical  offi- 
cer, if,  indeed,  at  any  time  his  interest  is  suffi- 
ciently excited  to  induce  him  to  deliberately 
study  the  case  exhaustively.  And  yet  untold 
numbers  of  insane  might  be  immediately  placed 
under  conditions  which  would  result  in  quick 
recovery  if  their  physical  condition  was  under- 
stood and  all  of  the  circumstances  of  their  ner- 
vous break-down  were  exactly  determined. 


PART  THREE 

THE  CARE  AND  TREATMENT  OF  THE 

INSANE 


XIII 
Mechanical  Restraint 


XIII 


Mechanical  Restraent 


HE    treatment   of   the   insane 
forms  one  of  the  saddest  chap- 
ters in  the  history  of  the  ev- 
olution of  human  society.     It 
is    one    continued    record    of 
savagery    down    to    our    own 
times.    Indeed,  we  have  scarce- 
ly  passed    from    under    the    shadows    of    the 
pernicious  influence  of  the  belief  in  the  demo- 
niacal possession   of  the  insane,   to 
A  Sad       which  we  may  trace  most  of  the  cru- 
Chapter     elties  practiced  upon  them.    That  su- 
perstition was  discarded  long  ago,  but 
its  results,  in  the  barbarous  treatment  of  the  in- 
sane, have  been  an  inheritance  which  clings  to 
us  with  a  tenacity  that  often  controls  public  pol- 
icy.   But  we  are  making  manifest  progress  in 
our  better  care  of  the  insane,  and,  fortunately, 
under  the  safe  and  sane  guidance  of  science  and 
the  humanitarian  spirit  of  the  age. 

Reviewing  the  dominating  forces  in  the  care 
and  treatment  of  the  insane  in  the  past,  and  at 

171 


172  WHO   IS   INSANE? 


present,  and  forecasting  them  for  the  future, 
we  should  give  for  the  past,  Mechanical  Re- 
straint, for  the  present.  Custodial  Care,  and  for 
the  future.  Curative  Treatment, 

It  is  along  the  lines  of  such  a  characteriza- 
tion that  The  question  of  care  and  treatment  of 
the  insane  can  be  most  intelligently  considered. 

Mechanical  restraint,  as  a  recognized  method 
of  treatment  of  the  insane,  ceased  during  the 
years  1882-1888.  When  I  performed  the  duties 
of  State  Commissioner  in  Lunacy  every  form 
of  appliance  for  the  restraint  of  the  disturbed 
insane  was  to  be  seen  in  constant  use.  They 
were  found  in  manacles,  in  "stocks,"  in  dun- 
geons, chained  to  posts,  strapped  in  bed,  etc. 

IN  one  alms-house  a  man  was  daily  brought  out 
of  a  stall  in  an  out-building,  where  he  had 
been  confined  twelve  years,  arms  pinioned  and 
led  by  his  keeper  precisely  as  a  dangerous  ani- 
mal  is   treated.    Meantime,    an- 
Treated  Like    other  man  cleaned  the  stall  and 
Animals         supplied  fresh  straw  for  his  bed. 
In     another     alms-house    seven 
women  were  found  in  separate  stalls  in  a  bar- 
rack in  a  state  of  indescribable  filthiness.  Their 
attendant,  or  keeper,  as  he  was  called,  was  a  de- 
mented man,  who  could  scarcely  answer  a  ques- 
tion. 

In  the  State  and  private  asylums  the  methods 


WHO  IS   INSANE?  173 

of  restraint  were  comparatively  mild,  as  con- 
finement in  isolation  rooms,  the  restraining 
sheet,  the  straight-jacket.  The  exceptional 
method  of  restraint  was  the  famous  "Utica 
Crib,"  which,  owing  to  the  heated  discussion  for 
and  against  mechanical  restraint,  obtained  a 
world-wide  reputation. 

It  consisted  of  a  box-bed  with  a  movable 
slat-cover  which  prevented  the  patient  from 
rising  and  was  designed  for  meeting  the  neces- 
sity of  maintaining  in  a  recumbent  position  fee- 
ble inmates  who  persisted  in  walking  about  the 
halls.  This  device  took  the  place  of  confine- 
ment in  bed  by  means  of  straps,  or  other  means. 
It  was  a  harmelss  affair  in  that  it  could  do  the 
patient  no  physical  injury;  and  when  used  for 
the  purposes  for  which  it  was  originally  made, 
was  very  beneficial.  On  a  visitor  who  saw  the 
patient  through  the  slatted  cover  the  impression 
was  liable  to  be  that  the  inmate  was  being  tor- 
tured, and  this  opinion  was  likely  to  be  con- 
firmed by  the  patient's  complaints  and  urgent 
request  to  be  relieved. 

The  era  of  Mechanical  Restraint  was  neces- 
sarily characterized  by  the  violence  of  the  in- 
mates of  asylums,  the  rudeness  of  attendants, 
and  absence  of  the  close  supervision  of  the 
officers.  A  disturbed  patient  safely  restrained 
by  whatever  means  was  angry  and  resentful, 
the  attendant  who  had  struggled  to  place  him 


174  WHO   IS   INSANE? 


in  restraint  was  elated  at  his  success,  however 
rudely  he  may  have  handled  him,  and  the  phy- 
sician in  charge  no  longer  feared  an  outbreak, 
and  therefore  his  anxiety  ceased. 


XIV 

Custodial  Care 


XIV 


Custodial  Care 


HE  records  of  many  institutions 
for   the   insane    show   that  by 
present  methods  of  treatment 
one-fourth  in  general,  and  one- 
third   at   best,   are    discharged 
from  the  asylums  cured.     And 
those    reported    cured    seldom 
recover    because     of     any    special     treatment 
adapted  to  their  individual  cases.     "They  just 
get  well,"  said  a  Superintend- 
Inadequacy  of     ent.       And    it    is     little    less 
Present  Method    than  a  miracle  that  even  one 
recovers    his    normal    mental 
equilibrium  amid  the  distractions  of  the  ordi- 
nary asylum. 

But  in  considering  the  question  of  the  cura- 
bility of  the  insane  it  is  a  most  encouraging  fact 
that  one-fourth  of  those  committed  as  insane 
actually  recovered  under  conditions  which  tend 
powerfully  to  unbalance  a  sound  mind.  It  is  a 
striking  proof  of  the  inherent  capacity  in  the 
cell  to  revert,  after  being  disturbed,  to  its  nor- 

177 


178  WHO   IS   INSANE? 

mal  state.  This  power  and  disposition  of  the 
cell  to  resume  its  original  function,  when  the 
disturbing  cause  is  removed,  has  been  shown  to 
be  one  of  its  most  important  features  in  con- 
serving and  maintaining  its  integrity. 

Another  peculiarity  of  the  cell  must  be  con- 
sidered, viz.,  that  when  a  cell  is  functionally  de- 
ranged it  tends  to  derange  other  cells  in  imme- 
diate relation  with  it,  as  occurs  in  anv  mechan- 
ism.  Hence,  the  importance  of  the  earliest  pos- 
sible cure. 

The  practical  question  which  the  preceding 
facts  suggest  is.  How  can  the  policy  of  the  State 
in  the  management  of  its  institutions  for  the  in- 
sane be  changed  so  as  to  enable  them  to  increase 
largely  the  ratio  of  cured,  or,  in  other  words, 
to  render  them  curative  as  well  as  custodial? 

In  all  the  conditions  which  pertain  to  the 
physical  health  and  comfort  of  the  inmates 
these  institutions  are  amply  equipped,  but  for 
custodial  rather  than  curative  purposes.  And 
in  all  of  the  details  of  management  as  custodial 
institutions  there  is,  only  exceptionally,  any  just 
ground  of  criticism.  The  governing  commis- 
sion and  the  local  managers  are  usually  ap- 
pointed with  due  discrimination  as  to  qualifica- 
tions. The  Medical  Staffs  take  high  rank  in 
the  profession  and  perform  their  official  duties 
with  skill. 

Nor  can  these  institutions  be  condemned  for 


WHO   IS   INSANE?  179 

failure  to  treat  the  inmates  humanely.  The  most 
constant  complaint  of  the  insane  is  cruel  treat- 
ment. The  forms  of  cruelty  alleged  are  of  ev- 
ery variety,  from  merely  refusing  the  discharge 
of  inmates  to  gross  kinds  of  corporal  pun- 
ishment. The  investigation  of  these  ever-re- 
curring complaints  of  ill-treatment  by  patients 
and  their  friends  established  the  fact  that  the 
insane  are  peculiarly  liable  to  construe  every 
act  of  restraint  or  discipline  as  a  form  of  per- 
sonal abuse.  Nor  is  it  difficult  to  explain  this 
tendency.  As  a  class  the  insane  are  intolerant 
of  restraint  of  any  and  every  kind.  They  resent 
all  interference  with  their  personal  liberty.  The 
supervision  and  discipline  required  and  en- 
forced in  institutions  are  rarely  submitted  to 
without  mental  disturbance,  taking  the  form 
often  of  physical  struggle.  If  the  attendant  re- 
sorts to  any  force,  however  mild  and  harmless, 
the  patient  is  thrown  into  a  paroxysm  of  rage 
which  requires  force  on  the  part  of  the  attend- 
ant to  control.  This  necessary  effort  of  the  at- 
tendant is  always  construed  as  an  assault. 

Although  it  is  a  fact  that  the  insane  in 
asylums  are  sometimes  too  rudely  treated,  and 
occasionally  unjustly  assaulted,  yet  a  careful  in- 
quiry as  to  the  truth  of  a  large  number  of  com- 
plaints satisfactorily  proved  that  such  occur- 
rences are  infrequent,  and  usually  result  from 
attacks  of  patients  upon  attendants,  who  lose 


180  WHO  IS   INSANE? 

self-control,  or  from  the  violent  resistance  of 
patients  to  the  rules  and  regulations  of  the  asy- 
lums. Indeed,  the  comparatively  small  number 
of  cases  of  abusive  treatment  which  were  proved 
to  be  cruel  and  unprovoked  by  the  conduct  of  the 
patients  was  a  most  gratifying  surprise. 

KNOWING  from  long  experience  how  diffi- 
cult is  the  task  of  securing  a  class  of  attend- 
ants upon  the  sick  in  general  hospitals,  who  will 
always  be  patient,  cheerful,  attentive,  and  con- 
siderate to  the  persons  in 
Cruel  Treatment  their  charge,  I  had  antici- 
Exceptional  pated  that  in  institutions  for 
the  insane  there  would  be 
found  far  greater  abuses  in  the  treatment  of 
the  inmates,  by  the  attendants,  than  in  hospital 
practice.  Certainly,  it  requires  a  higher  order 
of  mental  and  moral  character,  greater  self-con- 
trol, and  a  more  impressive  personality  to  win 
the  confidence  and  respect  of  the  insane  than  of 
the  patients  of  the  ordinary  hospital  ward.  And 
it  was  creditable  to  the  management  of  the  State 
Asylums  that  the  attendants  were  generally  found 
to  be  of  a  higher  grade  than  in  public  hospitals, 
and  that  they  exercise  a  degree  of  patience  and 
forbearance  under  most  trying  and  anno^dng 
circumstances  worthy  of  the  highest  commenda- 
tion. 


XV 

Curative  Treatment 


XV 


Curative  Treatment 


N  States  with  a  well  organized 
system   of   lunacy    administra- 
tion, the  question  is,  How  can  a 
research  and  curative  depart- 
ment,   thoroughly    adapted   to 
meet  the  requirements  of  mod- 
ern science,  be  engrafted  upon 
the  custodial  Asylums?  Fortunately,  these  State 
Asylums  are  generally  located  on  large  arable 
tracts  of  land  which  permit  the 
The  New       extension  of  the  present  arrange- 
Department     ment  of  buildings  to  any  desirable 
extent,  or  in  any  necessary  form. 
An  ideal  arrangement  of  the  ordinary  State 
Asylum,    admitting    the    incorporation    of    the 
curative  branch  of  the  service,  would  be  to  cre- 
ate the  following  divisions  of  administration, 
viz.,  the  Research,  the  Curative,  the  Industrial, 
the  Custodial,  and  the  Hospital.    The  object  of 
this  division  of  the  service  is  a  graded  classifi- 
cation of  the  inmates  in  the  order  of  develop- 

183 


184  WHO   IS   INSANE? 

ment  of  their  several  forms  of  mental  derange- 
ment. This  separation  into  specific  classes  in- 
sures far  greater  precision  in  the  details  of  care 
and  treatment  of  individual  inmates. 

Every  patient,  on  admission,  would  be  as- 
signed to  the  Research  Department,  where  an 
exhaustive  investigation  would  be  made  of  his 
or  her  life-history  and  present  physical  condi- 
tion. The  result  of  this  study  would  be  an  ac- 
curate diagnosis  of  every  essential  feature  of 
the  case  and  consequent  precision  in  determin- 
ing the  course  of  treatment  to  be  pursued. 
When  the  diagnosis  is  satisfactorily  made  the 
patient  is  transferred  to  that  one  of  the  other 
departments  adapted  to  the  conditions  found, 
viz.,  the  Curative,  the  Industrial,  the  Custodial 
or  the  Hospital.  In  the  organization  of  these 
departments  there  should  be  such  a  separation 
of  the  Curative  from  the  others  that  to  common 
observation  there  is  no  connection. 

THE  Curative  Department  should  be  under 
the  exclusive  control  of  a  Research  Staff, 
and  located  on  isolated,  picturesque  grounds, 
laid  out  and  cultivated  as  a  park.  The  buildings 
should  consist  of  such  a  number  of 
Cottages  cottages,  arranged  on  the  plan  of  a 
In  a  Park  village,  as  would  accommodate  in 
small  family  groups  all  of  the  pa- 
tients  admitted  for   a   period   of   six  months. 


WHO   IS   INSANE?  185 

There  should  he  cottages  for  the  resident  med- 
ical staff,  an  isolation  building  for  immediate 
care  of  the  disturbed,  a  gymnasium  and  a  li- 
brary. This  department  should  be  equipped 
with  every  device  necessary  to  accuracy  of  diag- 
nosis and  precision  in  the  use  of  remedial 
measures. 

The  purpose  of  the  isolated,  picturesque 
grounds  and  cultivated  park-garden  is  to  have 
the  entrance  of  the  patient  to  the  institution  as 
free  as  possible  from  the  disagreeable  and  often 
extremely  exciting  or  depressing  effect  which 
the  insane  experience  on  finding  themselves  in 
a  "Lunatic  Asylum." 

THE  Research  and  Curative  Departments,  be- 
ing closely  allied  in  their  objects,  should 
be  practically  one  in  organization  and  manage- 
ment.   The  official  head  should  be  a  board  con- 
sisting   of    an     Alienist,     a 
Departments        Physiologist,    a    Pathologist 
Under  Specialists    and  a  Psychologist,  each  be- 
ing of  the  highest  grade  of 
qualification  in  his  branch.     The  Physiologist, 
Pathologist  and  Psychologist  should  be  devoted 
to    the    Research    service,    which    should    be 
equipped  with  laboratories  and  every  other  nec- 
essary device  for  the  most  accurate  work.    Sub- 
ordinate  officers   as   field-workers,   should   be 
supplied  in  such  kind  and  manner  as  to  reach 
every  requirement. 


186  WHO   IS   INSANE? 

The  Alienist  should  have  the  supervision  of 
the  Curative  branch,  in  which  the  remedial 
measures  directed  by  the  Research  service  are 
practically  applied.  The  equipment  of  this  de- 
partment should  embrace  every  recognized 
means  or  appliance  for  curing  the  insane  not 
otherwise  available. 

The  residential  buildings  of  these  depart- 
ments should  be  cottages  adapted  to  family  life, 
so  located  and  constructed  that  there  is  the 
least  possible  contact  of  the  inmates  with  each 
other,  and  their  closest  possible  oversight  by 
attendants.  The  object  of  this  arrangement  is 
to  have  the  insane,  in  the  beginning  of  their 
treatment,  under  the  immediate  influence  of  a 
sound  rather  than  an  unsound  mind. 

The  resident  head  of  a  family  in  the  cottage 
should,  as  far  as  possible,  be  of  the  same  na- 
tionality or  occupation  as  the  patient,  in  order 
that  the  former  may  be  able  more  readily  to 
obtain  the  confidence  of  the  latter,  and  thus  un- 
consciously exert  a  controlling  power  over  him. 

The  plan  of  a  Research  and  Curative  depart- 
ment, above  sketched,  to  be  added  as  an  inte- 
gral part  of  the  great  State  Asylums  is,  of 
course,  susceptible  of  important  modifications, 
but  the  outline  given  will  serve  to  illustrate 
their  peculiar  features. 

In  practical  operation  in  an  Asylum,  a  patient 
would  enter  the  institution  and  might  be  under 


WHO   IS   INSANE?  187 

observation  and  treatment  for  a  considerable  pe- 
riod without  being  aware  that  he  was  in  a 
"Lunatic  Asylum."  When  the  record  of  his  life 
is  completed,  his  physical  condition  understood, 
and  the  precise  origin,  progress  and  trend  of  his 
mental  derangement  ascertained  he  would  be 
transferred  from  the  Research  Department  to 
his  proper  place  in  the  greater  institution.  He 
might  be  discharged  as  not  insane,  or  be  as- 
signed to  a  specific  form  of  treatment  in  the 
Curative  branch,  or  to  a  trade,  to  the  farm,  the 
Industries,  or  to  the  Custodial  division,  or  to 
the  Hospital.  Whatever  was  the  decision  as  to 
his  destination,  there  would  be  the  absolute 
certainty  that  the  State  had  exhausted  its  re- 
sources in  its  efforts  to  relieve  him  of  his  disa- 
bility and  restore  him  to  his  family  as  promptly 
as  his  condition  would  permit. 

WE  can  but  conclude  that,  in  the  light  of  the 
modern  physiological  and  psychological 
sciences,  we  are  not  making  proper  progress  in 
curing  the  insane  in  public  care.     Custody  has 

been  the  policy  of  the 
No  Real  Attempt  State,  and  as  a  result  the 
to  Cure  the  Insane  asylums  are  always  over- 
crowded and  there  is  a 
constant  demand  upon  Legislatures  for  large 
appropriations  to  increase  the  capacity  of  ex- 
isting institutions  and  to  establish  others. 


188  WHO   IS   ENSANE? 


The  conclusion  which  my  observations  forci- 
bly impressed  was  that  thousands  of  persons 
languish  in  Asylums  for  the  insane,  suffering 
from  curable  forms  of  neuroses  involving  dis- 
turbance, or,  more  accurately,  derangement  of 
the  functions  of  some  brain-cells.  They  have 
never  been  subjected  to  the  exhaustive  study 
by  scientific  experts  now  proposed,  and,  conse- 
quently, have  never  received  adequate  treat- 
ment. 

It  is  a  pertinent  question  for  the  most  serious 
consideration  of  those  who  control  the  policy 
of  the  State:  Might  not  the  per  cent,  of  "dis- 
charged as  cured"  from  our  Asylums  be  raised 
from  twenty-five  or  thirty-three  per  cent,  to 
eighty  or  ninety  per  cent.,  if  all  the  resources  of 
science,  art,  and  humanity  were  brought  into 
requisition  immediately  on  admission  of  each 
person  legally  committed  as  insane? 

It  may  be  alleged  that  the  installation  of  Re- 
search and  Curative  departments  in  our  great 
State  Asylums  would  be  so  expensive  as  to  be 
prohibitive.  That  objection  raises  another 
question,  viz.,  WouLi  it  not  be  more  economical 
to  cure,  by  the  proposed  organization,  even  fif- 
ty per  cent,  of  the  admitted  patients,  than  to 
maintain  them  fifteen  years,  the  allotted  life- 
time of  the  insane  in  Asylums? 

But  while  we  are  satisfied  of  the  economy  of 
the  reform  proposed,  there  is  a  question  of  far 


WHO   IS   INSANE?  189 


higher  import  than  that  of  economy  involved 
in  the  proposed  change  of  pohcy  in  the  treat- 
ment of  the  insane  by  the  State.  It  is  the  obli- 
gation of  the  State  to  restore  to  health  and  ac- 
tivity, in  the  briefest  possible  time,  citizens  who 
become  its  wards  by  the  accidents  of  disease, 
which  unfit  them  for  life  in  the  family  and 
communit}''. 

Dr.  Hering,  Secretary  of  the  Commission  in 
Lunacy  of  Maryland,  already  referred  to, 
makes  the  following  statement  as  the  result  of 
his  experience  in  visiting  institutions  for  the  in- 
sane: 

"There  are  approximately  one  hundred  and 
fifty  thousand  insane  people  in  the  United 
States,  a  large  proportion  of  whom  might  be 
cured  and  become  useful  citizens,  if  the  State 
Legislatures  would  appropriate  sufficient 
money." 


XVI 

Cure  the  Curable 


XVI 


Cure  the  Curable 


HE  curable  insane  are  those; 
whose  brain-cells  are  not  de- 
stroyed by  injury  or  disease, 
but  are  only  temporarily  dis- 
turbed in  their  function.  Thus, 
the  cells  may  absorb  from  the 
blood  a  substance  which  while 
it  remains  within  them  changes  their  action  as 
in  alcoholic  intoxication,  but  when  the  poison  is 
removed  the  cells  resume  their  normal  func- 
tions. 

Considering  the  extreme  susceptibility  of  the 
brain-cells    to    impressions   from   without    the 
body,  through  the  special  senses,  and 
Curable    from  within  by  the  absorption  of  dele- 
Cases      terious  waste  matters   (auto-intoxica- 
tion), it  is  apparent  that  the  number 
of  persons  suffering  from  temporary  mental 
derangement,  requiring  custodial  care,  must  be 
very  large,  and  greatly  in  excess  of  those  suf- 
fering from  destruction  of  the  same  cells  by  or- 
ganic diseases.    This  conclusion  is  sustained  by 

193 


194  WHO   IS   INSANE? 

a  comparison  of  the  functional  and  organic  dis- 
eases of  other  organs,  in  which  the  former  al- 
ways largely  predominate. 

We  may,  therefore,  justly  estimate  the  curable 
insane,  or  those  who  at  the  outset  of  their  men- 
tal aberrations  suffer  only  from  simple  disturb- 
ances of  brain-cell  functions,  as  much  more  nu- 
merous than  those  suffering  from  destructive 
organic  diseases.  Even  in  the  long-established 
State  institutions  for  the  insane  it  has  been  es- 
timated that  half  of  the  inmates  have  no  organic 
disease  of  the  brain. 


IN  the  Psychopathic  Hospitals,  where  persons 
are  admitted  for  observation,  their  conduct 
leading  to  the  suspicion  that  they  are  insane, 
the  number  found  to  be  suffering  from  tem- 
porary mental  derangement. 
Why  Are  Not  which  may  be  relieved  by  sim- 
More  Cured?  pie  measures,  is  so  large,  com- 
pared with  those  whose  delu- 
sions, illusions  or  hallucinations  are  permanent, 
as  to  confirm  the  belief  that  the  curable  insane 
are  greatly  in  excess  of  the  incurable,  on  first 
admission  to  asylums. 

If,  then,  a  large  proportion  of  the  insane  suf- 
fer only  from  functional  disturbances  of  brain- 
cells  in  the  incipient  stage  of  their  special  forms 
of    mental    aberration,    the    question    acutely 


WHO   IS   INSANE?  195 

arises,  Why  is  not  the  rate  of  cure  greatly  in  ex- 
cess of  the  twenty-five  to  thirty-three  per  cent, 
which  is  the  standard  of  success  in  pubHc  institu- 
tions devoted  to  their  care  and  treatment? 

The  science  and  art  of  healing  during  the  last 
half-century  has  made  great  advances  in  reduc- 
ing the  mortality  of  diseases  in  all  of  the  de- 
partments of  practice — medicine,  surgery,  ob- 
stetrics, gynecology,  therapeutics;  but  in  the  cure 
of  the  insane  psychiatry  has  made  no  corre- 
sponding advance  during  that  period. 

Dr.  Pliny  Earle  made  an  elaborate  study  of 
the  statistics  of  asylums  and  from  them  drew 
the  conclusion  that  the  final  results  of  the  ef- 
forts to  cure  the  insane  were  unfavorable,  owing 
chiefly  to  the  relapses  which  occur  in  those  dis- 
charged as  cured.  The  result  of  his  researches 
was  to  revive  in  the  minds  of  many  the  old  be- 
lief, "Once  insane  always  insane."  How  far  that 
author's  opinion  has  influenced  the  treatment 
of  the  insane  in  public  institutions  cannot  be 
determined,  but  as  his  statistics  were  the  results 
of  treatment  in  a  comparatively  primitive  pe- 
riod, they  do  not  illustrate  the  resources  of  mod- 
ern medical  science  and  art. 

Assuming,  therefore,  that  the  insane,  suffer- 
ing only  from  functional  derangement  of  brain- 
cells,  may  be  cured,  as  are  the  functional 
derangements  of  other  organs,  by  removing  the 
disturbing  cause  and  reducing  their  functional 


196  WHO   IS   INSANE? 

activity  to  a  minimum  until  their  integrity  is  re- 
stored, it  will  be  interesting  and  instructive  to 
inquire  as  to  the  susceptibility  of  the  insane  to 
curative  measures. 

It  is  noticeable  that  in  every  case  the  relief 
was  due  primarily  to  satisfying  a  desire  or  to 
divertion  therefrom. 


XVII 

Use  the  Usable 


XVII 

Use  the  Usable 

FEATURE  of  the  Asylum  life 
of  the  insane,  which  has  a  de- 
pressing effect  upon  their  phys- 
ical health  and  injuriously  con- 
centrates their  thoughts  upon 
the  special  objects  of  their  men- 
tal disturbance,  is  idleness.  A 
most  painful  impression  is  made  upon  the  vis- 
itor as  he  passes  from  ward  to  ward,  to  witness 
the  restlessness  and  irritability 
Evil  Effects  of  vast  numbers  of  stalwart 
of  Idleness  men  and  women,  due  largely  to 
the  absence  of  vigorous  labor  in 
the  open  air — labor  to  which  they  may  have 
long  been  accustomed.  The  cause  of  this  idle- 
ness is  due  chiefly  to  the  unwillingness  of  the 
insane  to  labor,  owing  to  their  grievance  at  be- 
ing adjudged  insane  and  confined. 

Refusal  to  labor  can  be  overcome  only  by 
compulsion  or  a  promise  of  reward.  The  re- 
ward may  be  money  or  favors  in  the  form  of 
privileges.     The  value  of  work  as  a  curative 


199 


200  WHO  IS   INSANE? 

measure  is  greatly  enhanced  when  the  laborer 
is  rewarded  and  he  performs  his  task  volun- 
tarily. On  this  account  the  Superintendents  of 
English  Asylums  are  allowed  a  reserved  fund 
with  which  to  pay  patients  who  labor. 

On  the  part  of  the  management  the  excuse 
for  not  securing  more  work  from  the  insane  is, 
first,  and  generally,  that  it  requires  so  much 
time  and  effort  to  care  for  the  laborers,  while 
employed,  their  labor  is  too  expensive;  and  sec- 
ond, that  the  task  itself  is  too  often  of  such  lit- 
tle money  value  as  to  discourage  efforts  to  make 
large  numbers  of  the  more  demented  class 
work. 

While  these  objections  to  "wasting  the  time" 
of  attendants  in  efforts  to  make  the  insane  work 
have  apparently  much  weight,  as  an  economic 
feature  of  the  management,  we  must  not  lose 
sight  of  the  fact  that  a  well-planned  system 
of  toil  is  the  most  successful  curative  measure 
for  the  physically  able  insane  yet  devised.  For- 
tunately the  State  Asylums  and  Hospitals,  with 
their  ample  farm  and  garden  lands,  furnish  the 
necessary  opportunity  for  developing  indus- 
tries adapted  to  the  physical  and  mental  pecu- 
liarities of  every  inmate  capable  of  doing  any 
kind  of  work. 

The  following  cases  illustrate  interesting  feat- 
ures of  the  usefulness  of  the  insane: 
A  Superintendent  was  impressed  with  the  in- 


WHO   IS   mSANE?  201 

fluence  which  an  inmate  of  a  ward  devoted  to 
a  very  disturbed  class  exercised  over  his  asso- 
ciates. Though  he  was  an  incorrigible  patient 
as  regards  obeying  attendants,  being  always 
the  leader  of  outbreaks  of  the  more  violent,  the 
Superintendent  determined  to  place  him  in 
charge  of  the  ward  and  thus  utilize  his  peculiar 
power  over  the  disturbed  patients.  On  making 
this  proposal  to  him  he  refused  to  assume  the 
care  of  such  an  unruly  "lot  of  insane  devils," 
as  he  called  them,  unless  he  was  paid  one  mil- 
lion dollars  a  day.  The  Superintendent  ac- 
cepted his  offer  and  he  entered  upon  his  duties, 
and  from  that  time  this  ward  was  the  most  or- 
derly in  the  Asylum.  The  new  attendant  went 
regularly  to  the  office  daily  and  received  a 
check  for  the  stipulated  amount.  If  for  any  rea- 
son he  did  not  receive  it  he  notified  the  Super- 
intendent that  he  should  "knock  off  work"  until 
he  was  paid. 

One  of  the  best  laborers  on  an  asylum  farm, 
especially  in  the  cultivation  of  corn  and  pota- 
toes, was  an  elderly  farmer  who  was  so  de- 
mented that  when  he  reached  the  end  of  a  row 
he  would  continue  on  in  a  straight  line  search- 
ing for  the  plants,  even  climbing  over  neighbor- 
ing fences  for  that  purpose.  He  always  had  a 
companion  at  his  work  who  would  turn  him 
about  at  the  end  of  each  row. 


202  WHO   IS   INSANE? 

A  feature  of  a  County  Asylum  was  a  stalwart 
farmer  working  a  well-groomed  mule.  On  in- 
quiry I  learned  that  he  had  been  a  most  un- 
governable inmate  of  a  State  Asylum  and  was 
returned  to  the  County  as  an  incorrigible.  He 
seldom  spoke  without  using  the  word  "mule." 
The  Keeper,  a  shrewd,  practical  man,  was  im- 
pressed with  the  extreme  restlessness  of  the 
man  and  his  frequent  use  of  the  word  "mule," 
which  seemed  to  be  the  suggestion  of  his  sub- 
conscious mind.  Adopting  quite  unconsicously 
the  method  of  psycho-analysis  he  determined  to 
learn  the  occasion  of  his  using  that  word  as  a 
possible  clew  to  the  cause  of  his  mental  disturb- 
ance. On  visiting  the  home  of  the  farmer  the 
Keeper  learned  that  he  had  gradually  developed 
a  fondness  for  an  old  mule  and  finally  would  do 
no  other  work  than  drive  this  animal  about  the 
farm  and  neighborhood;  whatever  work  could 
be  done  by  the  mule  and  the  farmer  together — 
ploughing,  carting — was  always  well  and  thor- 
oughly done.  His  devotion  to  the  mule  finally 
became  such  a  nuisance  that  he  was  committed 
to  an  asylum  as  a  hopeless  dement. 

The  Keeper  had  the  mule  transferred  to  the 
County  Farm  and  placed  in  charge  of  the 
farmer.  The  effect  was  immediate;  he  spoke  to 
the  mule  in  affectionate  terms  and  from  that 
time  was  as  docile  as  a  child.  He  became  one 
of  the  most  useful  men  in  the  colony  and  never 
manifested  any  irritability,  but  was  continually 
planning  work  which  he  and  the  mule  could  do. 


WHO   IS   INSANE?  203 


These  cases  suggest  Freud's  "Psycho-analy- 
sis," which  Max  Eastman  says  means  analysis 
of  the  soul,  or  mind.  The  theory  is  that  count- 
less numbers  of  diseases  that  we  call  nervous, 
or  mental,  and  countless  others  that  we  do  not 
name,  are  caused  by  desires  which  dwell  in  our 
minds  without  our  knowing  they  are  there.  His 
contention  is  that  if  the  patient  is  made  clearly 
aware  of  these  desires  their  morbid  effects  will 
disappear,  and  it  is  equally  true  that  if  these 
desires  are  satisfied  they  will  cease  to  disturb 
the  mind.  Freud  thinks  a  large  part  of  the 
sickness  and  trouble  in  the  world  is  caused  by 
desires  which  we  have  refused  to  think  about, 
but  which  live  their  life  of  imagination  below 
the  surface  of  our  minds  and  act  through  it 
whether  we  will  or  no.  Most  of  these  trouble- 
making  desires  are  related  to  the  sex  life — first, 
because  sex  desires  are  so  strong,  and,  second, 
because  they  are  so  urgently  repressed  by  cul- 
ture, conscience  and  convention. 

CONVERSING  with  a  physician  in  a  large 
practice,  he  stated  that  he  had  long  labored 
under  this  disadvantage  in  his  treatment  of  his 
patients,  that  if  he  touched  the  medicine  which 

he  prescribed  it  had  the  effect 
The  Delusion  of     on    the    sick    of    morphine. 
a  Physician         When  I  expressed  a  doubt  as 
to  the  power  of  his  touch  to 
change  the  therapeutical  effect  of  a  drug,  he  be- 
came excited  and  declared  with  an  oath  that 


204  WHO   IS   INSANE? 


ever  since  he  was  poisoned  by  morphine  his 
touch  transmuted  drugs  into  morphine.  On  di- 
verting his  attention  to  other  professional  sub- 
jects he  proved  to  be  a  most  instructive  conver- 
sationahst,  and  I  learned  that  he  ranked  with 
the  first  members  of  his  profession  as  a  prac- 
titioner, but  he  had  to  administer  medicines  by 
prescription. 

The  failure  of  asylum  officers  to  secure  pro- 
ductive labor  from  the  insane  is  due  largely  to 
the  State's  policy  of  regarding  and  managing 
these  institutions  as  custodial  rather  than  cura- 
tive institutions.  The  custodial  policy,  which 
tends  to  treat  the  inmates  en  masse,  is  antago- 
nistic to  the  curative,  which  individualizes  the 
patients  and  applies  its  remedies  to  the  special 
peculiarities  of  each.  Success  in  the  manage- 
ment of  the  former  is  estimated  by  the  number 
in  care  and  the  creature  comforts  supplied, 
while  the  latter  estimates  its  success  by  the  num- 
ber discharged  cured  and  improved,  and  the 
economies  effected  by  the  productive  labor  of 
the  inmates. 

It  is  impossible  to  estimate  the  gain  to  the 
State,  not  only  of  productive  labor  in  its  insti- 
tutions for  the  insane,  but  in  the  recovery  and 
discharge  of  self-supporting  inmates  cured  by 
labor,  if  a  branch  of  the  service  of  each  were 
thoroughly  equippecl  for,  and  devoted  to,  the 
cure  of  the  insane  by  some  form  of  mental  di- 
version and  physical  labor. 


WHO   IS   ESrSANE?  205 


Dr.  Hering,  Secretary  of  the  Commission  in 
Lunacy  of  the  State  of  Maryland,  says : 

"I  contend  that  nine  hundred  and  ninety-nine 
out  of  every  one  thousand  patients  can  be  so  im- 
proved in  condition  by  proper  treatment  and 
proper  environment  as  to  make  them  in  every 
case  partially  self-supporting  and  in  a  great 
many  cases  entirely  self-supporting.  Not  only 
can  they  be  made  self-supporting,  but  self-care- 
ing." 


XVIII 
Voices  from  the  Asylums 


XVIII 

Voices  From  the  Asylums 

iT  is  not  often  that  we  listen  or 
give  credence  to  a  voice  from 
the  asylum  wards.  But  in  the 
following  statement  a  lady  of 
great  intelligence  gave  her  ex- 
perience in  an  asylum  when 
Mechanical  Restraint  was  the 
prevailing  method  of  controlling  the  disturbed 
or  violent  patients : 

"The  whole  system  of  treating 
Views  of  the  insane  in  asylums  is  wrong  and 
an  Inmate  makes  more  cases  chronic  than  it 
cures.  I  am  a  school  teacher  by 
profession,  trained  from  childhood  in  self-care, 
especially  in  personal  cleanliness,  dress  and 
manners.  I  was  brought  here  under  pretense 
that  I  was  going  to  a  sanitarium  to  convalesce 
after  a  long  spell  of  sickness.  On  arriving  I  was 
escorted  to  the  door  by  my  nurse,  a  refined 
young  woman,  who,  I  understood,  was  to  be  my 
companion  while  I  remained  in  the  sanitarium. 
At  the  door  we  were  met  by  a  man  who  took  me 

209 


210  WHO  IS  INSANE? 


alone  to  an  office  where  a  clerk  made  a  record 
of  some  facts  of  my  life.  Then  a  nurse  was 
called,  a  coarse  Irish  woman,  who  led  the  way 
to  a  hall  where  there  were  forty  insane  women. 
I  inquired  for  the  nurse  who  came  with  me 
and  was  to  attend  me  in  the  sanitarium.  "Sani- 
tarium!' said  my  guide.  'Eh!  So  they  deceived 
you  by  calling  a  lunatic  asylum  a  sanitarium! 
Your  friend  skipped  at  the  door,  as  do  many 
who  bring  lunas  here.' 

"I  was  ushered  into  a  room  where  there  was  a 
a  large  number  of  women,  who  terrified  me  by 
their  insane  acts,  and  was  assigned  to  a  small 
room  whose  only  furniture  was  a  low  bed  with 
dingy,  soiled  clothing.  I  was  ordered  to  undress 
and  prepare  for  a  bath.  I  told  the  nurse  that  I 
had  had  a  bath  that  morning,  but  she  said,  'That 
makes  no  difference,'  and  I  went  with  her  to  the 
bath-room,  which  was  a  common  receptacle 
with  a  repulsive  looking  tub  from  which  I 
shrank. 

"Under  a  threat  that  I  would  be  forcibly  put 
in  the  tub  if  I  resisted,  I  complied,  but  begged 
that  I  be  allowed  to  use  my  own  toilet  articles, 
which  I  had  brought.  This  request  was  refused, 
and  I  was  forcibly  held  while  towels  were  used 
which  sickened  me  at  the  very  sight.  When  the 
nurse  approached  me  with  a  filthy  hair-brush 
and  comb,  I  again  begged  to  be  allowed  to  use 
my  own,  which  were  in  my  bag,  but  the  nurse 


WHO  IS   INSANE?  211 

made  no  reply  and  attempted  to  comb  my  hair, 
which  I  resisted  by  placing  my  hands  on  my 
head.  She  called  an  assistant,  a  very  strong 
Irish  woman,  who  pinioned  my  arms  in  her 
grasp,  while  the  nurse  appHed  the  comb  and 
brush  with  such  harshness  that  I  cried  with 
pain. 

"This  part  of  my  toilet  over,  the  nurse  brought 
a  ward  dress  and  directed  me  to  put  it  on. 
Again  I  remonstrated  and  asked  the  privilege  of 
wearing  my  own  dress,  but  it  was  refused,  and 
I  was  forcibly  assisted  in  putting  on  the  old  and 
ill-fitting  garments. 

I  WAS  finally  taken  to  my  room  perfectly  ex- 
hausted by  my  excitement,  excessively  un- 
comfortable in  my  shabby  dress,  terrified  by  the 
screams  of  patients,  and  deeply  resentful  be- 
cause of  the  deceitful  method 
The  Effect  of  a  which  my  friends  had  pursued 
Rude  Reception  in  securing  my  admission  to 
the  asylum.  I  passed  a  horri- 
ble night,  sometimes  screaming  to  relieve  the 
nervous  tension  which  I  suffered.  For  this  act 
the  night  watch  threatened  to  put  me  in  the 
'Seclusion  Room,'  which  so  alarmed  me  that  I 
did  not  dare  to  speak,  but  sought  relief  by  walk- 
ing the  floor  and  wringing  my  hands. 

"When  the  'rising-belF  rang  I  was  so  ex- 
hausted that  I  did  not  feel  able  to  stand,  and  sat 


212  WHO   IS   INSANE? 


on  the  side  of  the  cot,  but  the  attendant  ordered 
me  to  dress  and  go  out  on  the  hall.  I  finally 
succeeded  in  getting  into  the  filthy,  striped 
ward  dress,  and  the  feeling  crept  over  me  that 
I  was  a  prisoner  for  life.  In  the  hall  I  was  con- 
fronted by  a  dozen  insane  women,  who  gath- 
ered about  and  stared  at  me  as  if  I  were  a  wild 
beast.  With  these  poor  creatures  I  had  to  take 
my  breakfast,  for  which  I  had  but  little  relish 
in  their  presence. 

"When  the  physician  made  his  morning  visit 
I  attempted  to  speak  with  him,  but  the  attendant 
explained  my  case  to  him,  placing  great  stress 
on  my  resistance  in  the  bath  and  my  disturb- 
ance of  the  ward  at  night.  On  my  attempting 
to  explain  he  listened  for  a  moment  with  a 
bored  look,  then  waved  me  away  and  passed 
on  without  a  word  of  advice.  I  made  several 
efforts  to  speak  with  him  afterwards,  but  with 
no  better  success,  and  now  it  is  more  than  a  year 
since  my  admission,  and  no  one  has  examined 
me  to  determine  my  condition  or  to  give  me  ad- 
vice." 

She  continued  her  narrative  at  much  greater 
length,  and  then  gave  her  views  as  to  the  proper 
treatment  of  the  insane,  which  were,  in  sub- 
stance, as  follows : 

"If  I  had  met  at  the  door  of  the  asylum  an  in- 
telligent lady,  who  would  have  taken  me  to  a 
private  room,  and  there  in  a  sympathetic  man- 


WHO  IS   INSANE?  21 


Q 


ner  explained  that  this  institution  was  a  sani- 
tarium for  nervous  people;  that  I  would  proba- 
bly soon  recover  my  health;  that  it  was  neces- 
sary to  have  very  strict  rules,  where  there  were 
so  many  nervous  persons;  that  she  wished  me  to 
take  a  bath  before  retiring,  as  that  was  re- 
quired; and  if  she  had  given  me  my  toilet  arti- 
cles, and  then  had  given  me  a  quiet,  decently 
furnished  room,  I  should  have  had  all  my  fears 
removed  and  should  have  passed  a  comforta- 
ble night. 

"In  the  morning  the  same  lady,  or  one  equally 
intelligent  and  sympathetic,  should  have  taken 
me  to  a  private  table,  then  for  a  walk  or  drive, 
meanw^hile  inquiring  into  the  peculiarities  of 
my  case  and  encouraging  me  with  the  hope  of 
early  recovery.  On  the  same  morning  the  physi- 
cian should  have  thoroughly  but  sympathet- 
ically examined  me  in  private,  determined  my 
course  of  treatment,  and  assured  me  of  my  early 
recovery,  or,  at  least,  have  said  some  kind  and 
encouraging  word.  But  from  the  day  I  entered 
until  the  present  I  have  not  had  five  minutes' 
continuous  conversation  with  him.  Though  a 
Seminary  graduate,  second  in  my  class,  a  teach- 
er for  ten  years,  and  an  author,  my  only  com- 
panionship for  a  year  has  been  that  of  these 
poor  women,  and  we  have  nothing  in  common 
but  our  miseries." 

Perhaps    these    statements    are   exaggerated. 


214  WHO   IS   ESrSANE? 


but  there  is  sufficient  truth  to  make  them  worthy 
of  record.  The  method  of  having  ordinary  em- 
ployees receive  patients  who  are  always  in- 
tensely sensitive  and  usually  greatly  excited  on 
being  taken  to  an  asylum  for  the  insane,  is  liable 
to  aggravate  their  mental  disturbance  unneces- 
sarily. The  cold  and  repulsive  treatment  which 
they  receive  from  attendants  on  admission  cre- 
ates a  prejudice  from  which  the  patient  never 
recovers.  The  first  introduction  to  a  hall  filled 
with  the  insane;  the  want  of  genial  companion- 
ship; the  neglect  of  the  physician,  as  described 
by  this  lady,  are  incidents  in  the  life  of  the  in- 
sane in  public  care  which  ought  to  be  remedied. 

TREAT  me  like  a  man  and  I  will  treat  you 
like  a  man;  treat  me  like  a  brute  and  I 
will  treat  you  like  a  brute.*'  This  was  the  chal- 
lenge of  an  old  man  who  had  been  admitted  to 
an  asylum  as  insane.    No  atten- 
"TreatMe        tion  was  given  to  what  was  re- 
LikeaMan**      garded  as  the  conceit  of  a  dis- 
eased brain  and  he  was  assigned 
to  a  hall  with  inmates  of  the  disturbed  class.    It 
naturally  happened  that  the  old  man  soon  took 
offense  at  his  treatment  by  the  attendant  and  he 
resented  it  by  destroying  everything  possible  in 
his  room.     For  these  acts  he  was  subjected  to 
various  forms  of  restrictive  treatment,  which  he 
as  persistently  resented.    His  violence  became  so 


WHO   IS   INSANE?  215 

uncontrollable  and  his  destructive  habit  so  dan- 
gerous that  he  was  "the  terror"  of  two  asylums 
which  successively  had  the  care  of  him. 

One  of  the  younger  members  of  the  resident 
staff  of  physicians  was  passing  the  window  of 
the  room  where  the  old  man  had  long  been  con- 
fined and  heard  the  familiar  challenge,  "Treat 
me  like  a  man  and  I  will  treat  you  like  a  man; 
treat  me  like  a  brute  and  I  will  treat  you  like  a 
brute."  The  young  physician  was  struck  as 
never  before  with  the  propriety  of  this  pathetic 
appeal  and  the  necessity  of  accepting  the  chal- 
lenge. He  sought  the  Superintendent  and  pro- 
posed to  take  the  patient  under  his  personal 
charge  and  give  him  the  benefit  of  a  trial  of 
his  pledge.  The  Superintendent  at  first  refused, 
but  consented  when  the  physician  promised  to 
be  personally  responsible  for  the  damage  which 
the  patient  might  commit. 

Going  to  the  patient's  room  the  physician  ac- 
costed him  with  a  slap  on  the  shoulder  and  the 
hearty  greeting,  "See  here,  my  friend,  come  with 
me  to  my  rooms,  for  I  intend  to  have  you  take 
charge  of  them  and  assist  me."  With  a  sob  the 
patient  grasped  the  physician's  hand  and  said, 
"That  is  the  first  kind  word  that  has  been  spo- 
ken to  me  in  five  years."  He  proved  true  to  his 
word  and  so  faithfully  performed  all  the  duties 
assigned  to  him  that  he  was  finally  placed  in 
charge  of  gangs  of  working  patients.     In  one 


216  WHO   IS   INSANE? 


instance  he  superintended  the  pruning  of  a 
large  orchard  by  inmates,  each  armed  with 
an  axe. 

He  was  finally  discharged  and  supported  him- 
self comfortably  for  several  years,  always  main- 
taining that  he  would  at  all  times  have  faith- 
fully fulfilled  his  promise  to  treat  any  officer* 
or  attendant  of  the  asylum  as  a  man  if  he  had 
been  treated  as  a  man. 

How  different  would  have  been  the  history 
of  this  man  if  he  had  been  properly  examined, 
on  his  admission  to  the  asylum,  and  if  an  ef- 
fort had  been  made  to  test  his  demand  at  once, 
instead  of  waiting  five  years! 


XIX 

State  Care  of  the  Insane 


XIX 


State  Care  of  the  Insane 


HE  deplorable  condition  of  the 
insane  in  county  care,  re- 
vealed on  my  first  inspection 
in  1882,  and  the  excellent 
care  which  the  same  class  was 
receiving  in  State  Asylums, 
convinced  me  that  I  could  do 
no  service  more  immediately  useful  and 
of   more   lasting   benefit    to    the    insane    than 

to  secure  their  removal  to 
State  Instead  of  the  State  institutions  and 
County  Care  close  the  alms-houses  for- 
ever to  their  admission.  I 
had  no  conception  of  the  opposition  which  a 
proposition  so  manifestly  just  and  feasible 
would  meet,  nor  of  the  sources  of  that  opposi- 
tion. 

Accordingly,  in  1883,  I  drew  a  bill  providing 
for  the  gradual  transfer  of  the  insane  from  the 
alms-houses  to  the  State  Asylums,  the  object 
being  to  remove  at  first,  and  immediately,  the 
more  disturbed  inmates  who  were  treated  by 

219 


220  WHO   IS   INSANE? 


means  of  the  most  severe  forms  of  mechanical 
restraint.  The  measure  was  first  submitted  to 
the  county  officials  by  whom  it  was  received 
wdth  general  opposition  as  a  method,  concocted 
by  the  State  Asylum  Managers,  of  depriving  the 
counties  of  their  rightful  privileges.  The  preju- 
dice against  the  State  asylums  for  the  inroads 
they  already  had  made  upon  the  insane  popula- 
tion formerly  in  county  "poor-houses,"  was  in- 
tense, and  it  was  soon  evident  that  only  opposi- 
tion from  that  source  could  be  expected. 

The  proposed  reform  was  discussed  with  the 
Managers  of  the  State  Asylums  as  opportunity 
offered,  but  was  not  generally  well  received  on 
account  of  the  opposition  which  it  was  believed 
the  counties  would  make  to  any  further  en- 
croachments upon  the  poor-house  population, 
and  the  undesirability  of  adding  chronic  dis- 
turbed insane  to  their  number. 

The  subject  was  also  discussed  with  the  mem- 
bers of  the  State  Board  of  Charities,  which  then 
had  visitatorial  supervision  of  all  of  the  insane 
in  custody.  The  older  members  opposed  any 
such  change  and  advocated  the  adoption  of 
measures  which  would  improve  the  care  of  the 
insane  by  the  counties,  the  principal  change 
being  the  creation  of  County  Insane  Asylums. 
That  plan  was  adopted  by  some  counties,  and 
under  the  closer  supervision  of  the  State  Board  of 
Charities    considerable    improvement    was    ef- 


WHO   IS   INSANE?  221 


fected.  But  at  the  best  their  management  was 
far  below  the  standard  established  by  the  State 
institutions  and  emphasized  the  necessity  of  fi- 
nally placing  all  of  the  insane  in  the  care  of 
the  State. 

IMPRESSED  with  the  urgency  of  this  reform  I 
prepared  another  bill  which  would  more  im- 
mediately and  totally  remove  the  insane  from 
the    alms-houses.      Having    failed    to    secure 
the  co-operation  of  any  ade- 
Bow  State  Care    quale  number  of  persons,   or 

Was  Secured  organizations  capable  of  secur- 
ing the  passage  by  the  Legisla- 
ture of  a  measure  destined  to  meet  with  the 
most  powerful  opposition,  I  decided  to  appeal 
to  the  State  Charities  Aid  Association,  a  vol- 
untary organization  devoted  to  the  improve- 
ment of  the  State  Charities.  On  submitting  the 
measure  to  Miss  Louisa  Lee  Schuyler,  the 
founder  of  the  Association,  and  an  uncompro- 
mising advocate  of  reform  of  these  institutions, 
she  declined  at  first  to  have  the  Association  un- 
dertake a  work  of  such  magnitude,  but  several 
months  later  she  informed  me  that  if  the  bill 
was  approved  by  the  President  of  the  Associa- 
tion, Prof.  Theodore  W.  Dwight,  she  would  ad- 
vise undertaking  its  passage  by  the  Legislature. 
The  bill  was  submitted  to  Prof.  Dwight,  who 
proposed  some  changes  in  the  phraseology,  but 


222  WHO   IS    INSANE? 


decidedly  approved  the  effort  to  secure  the  re- 
form which  the  measure  would  effect. 

Preparatory  to  the  introduction  of  the  bill 
into  the  Legislature,  I  deemed  it  very  impor- 
tant to  secure  the  cooperation  of  the  Presi- 
dent of  the  State  Board  of  Charities,  Hon.  Os- 
car Craig,  of  Rochester,  a  lawyer  of  a  thor- 
oughly judicial  mind,  of  profound  convictions 
of  justice  and  righteousness  and  of  a  pleasing  but 
impressive  personality.  As  he  was  unfamiliar 
with  the  condition  of  the  insane  in  the  County 
Asylums,  having  visited  with  me  in  committee 
only  the  insane  in  the  State  institutions,  a  reso- 
lution was  passed  by  the  State  Board  of  Chari- 
ties, on  my  suggestion,  requesting  the  President 
to  visit  the  County  Asylums  and  report  on  their 
condition.  Accordingly  Mr.  Craig  visited  these 
Asylums  in  the  summer  of  1888  and  as  a  result 
earnestly  approved  a  measure  which  would  ef- 
fect the  transfer  of  the  insane  from  County  to 
State  care. 

The  amended  bill  was  introduced  into  the 
Legislature  of  1889  and  its  passage  urged  with 
the  powerful  forces  at  the  command  of  the  State 
Charities  Aid  Association.  Conspicuous  among 
its  advocates  was  President  Craig,  representing 
the  State  Board  of  Charities,  who  was  actuated 
by  personal  knowledge  of  the  conditions  of  the 
insane  in  county  care.  The  opposition  was 
chiefly  from  the  adherents  of  the  alms-houses, 


WHO   IS   INSANE?  223 


represented  by  local  political  organizations.  The 
bill  became  a  law  in  1889,  thus  closing  forever 
the  "Poor-Houses"  of  the  State  against  the  ad- 
mission of  the  insane  poor. 

Estimating  the  importance  of  the  change  in 
the  care  of  the  insane  effected  by  this  measure 
in  the  light  of  nearly  a  quarter  of  a  century's 
experience,  the  "State-Care  Act"  of  New  York 
takes  its  place  with  the  most  advanced  and  sal- 
utary reforms  of  that  period.  Other  States  have 
followed  the  example  of  New  York,  and  the 
"Poor-House"  as  a  residence  of  the  insane  is 
destined  to  be  only  a  recorded  fact  in  history. 

AT  the  close  of  my  term  of  service  as  State 
Commissioner  in  Lunacy,  in  1888,  the  total 
number  of  insane  in  the  various  institutions  was 
about  20,000.  The  system  of  lunacy  administra- 
tion   had    as    yet    no 
A  Proper  Commission     properly  organized 
in  Lunacy  method,  but  had  been 

the  accidental  growth 
of  years,  from  the  old-time  custody  in  the  jail  or 
alms-house  to  the  care  and  treatment  of  the 
State  Asylum.  Each  stage  of  progress  was,  how- 
ever, marked  by  a  popular  agitation  favorable 
to  the  more  humane  treatment  of  the  insane.  It 
was  apparent  from  my  experience  that  the  pop- 
ulation of  insane  had  reached  a  limit  that  ren- 
dered it  necessary  for  adequate  supervision  by 


224  WHO    IS    INSANE? 

the  State,  and  that  there  should  be  a  properly 
constituted  Commission,  created  with  adequate 
visitatorial  and  supervisory  powers. 

Accordingly,  in  1888,  I  prepared  a  bill  creat- 
ing a  State  Commission  in  Lunacy.  The  per- 
sonnel of  the  Commission  consisted  of  a  Medical 
member,  a  Legal  member  and  a  Business  mem- 
ber. These  three  members  represented  the 
three  important  interests  of  the  institu- 
tions for  the  insane.  While  the  Commission  had 
not  the  power  of  direct  administration  of  the 
affairs  of  the  asylums,  which  was  continued  in 
local  boards,  it  had  such  advisory  powers  and 
supervision  of  details  as  would  enable  it  to  ex- 
ercise a  controlling  influence  upon  the  manage- 
ment. The  bill  passed  the  Legislature  some- 
what in  advance  of  the  State-Care  Act,  as  was 
intended,  in  order  that  when  the  latter  went 
into  effect,  there  would  be  a  competent  author- 
ity prepared  to  organize  and  direct  the  changed 
policy  of  the  State. 

The  Commission  in  Lunacy  has  fully  met  the 
purposes  of  its  establishment.  The  personnel 
of  the  Commission  has  been  judiciously  selected 
by  the  State  Executives  for  nearly  a  quarter  of 
a  century,  and  during  that  period  there  has 
been  scarcely  a  criticism  of  its  acts.  Upon  the 
members  of  the  Commission  first  appointed  the 
greatest  responsibility  rested,  and  it  proved 
fortunate  for  the  State  that  its  President  was 


WHO  IS   INSANE?  225 

Dr.  Carlos  F.  Macdonald,  a  man  eminent  in  his 
profession  and  of  an  exceptionally  large  and 
varied  experience  in  the  management  of  the 
State  Asylums.  Under  the  fostering  care  of  the 
Commission,  the  insane  of  the  State  of  New 
York  are  receiving  the  highest  grade  of  humane 
care.  In  all  that  pertains  to  creature  comforts 
— food,  clothing,  housing,  freedom  from  cruel 
forms  of  restraint — the  equipment  and  manage- 
ment of  the  State  Hospitals  excel. 

THERE  was  a  feature  in  the  practical  appli- 
cation of  these  two  Legislative  acts  that 
might  have  accomplished  more  desirable  results 
had  it  been  adopted  and  enforced  on  the  en- 
trance of  the  former  occu- 
Another  Reform  pants  of  the  alms-houses  into 
Much  Needed  the  State  Hospitals.  One  of  the 
objections  of  the  managers  of 
these  Hospitals  to  the  transfer  of  the  insane  of 
the  alms-houses  was  that  they  were  a  chronic 
class  of  low  order  and  had  never  had  any  dis- 
cipline. Hence  they  would  tend  to  disturb  the 
management  by  their  violence  and  degrade  the 
service  by  their  physical  and  mental  inferiority. 
The  objection  was  well  taken  and  raised  an  im- 
portant question  as  to  the  best  method  of  avoid- 
ing such  an  undesirable  result. 

It  was  suggested  that  as  these  Hospitals  had 
under   their   control  large   acreages   of  farm- 


226  WHO  IS  INSANE? 


lands  it  would  be  practicable  to  segregate  them, 
with  the  chronic  insane  already  in  the  Hospital, 
in  colonies,  supplied  with  simple  and  inexpen- 
sive cottages  where  the  inmates  would  live  in 
families  and  be  trained  to  useful  labor.  This 
arrangement  would  have  relieved  the  existing 
buildings  of  a  considerable  population  and  ad- 
mitted of  larger  opportunities  and  greater  facil- 
ities for  the  treatment  of  recently  admitted 
cases.  Unfortunately  the  managers,  with  few 
exceptions,  proceeded  to  build  new  structures 
in  immediate  contact  with  the  existing  build- 
ings, thus  reducing  the  entire  population  to  the 
common  level  of  a  custodial  institution  and  im- 
pairing its  more  important  function  of  curing 
the  insane. 

HAVING,  in  1872,  assisted  in  establishing  the 
first  "Training  School  for  Nurses,"  in  Belle- 
vue  Hospital,  New  York,  and  having  experi- 
enced the  remarkable  reform  which  they  made 

in  the  care  of  the  sick  in  my 
Training  Schools     own  wards,  the  first  impres- 
f  or  Nurses  sions  I  received  on  visiting 

the  wards  of  the  asylums  for 
the  insane  were  unfavorable,  owing  to  the  ab- 
sence of  the  uniformed  attendant  or  nurse.  My 
proposition  to  organize  Training  Schools  for  the 
education  of  attendants  in  asylums  was  not  well 
received  by  either  medical  officers  or  attend* 
ants. 


WHO   IS   INSANE?  227 

At  length,  however,  it  was  discovered  that 
one  of  the  medical  staff  of  the  Buffalo  Asylum, 
Dr.  William  D.  Granger,  was  giving  to  the  at- 
tendants of  that  institution  instruction  in  the  art 
of  nursing  and  had  prepared  a  manual  on  that 
subject.  His  interest  in  the  organization  of  a 
school  for  the  training  of  attendants  was  so 
great  that  it  was  not  difficult  to  obtain  the  con- 
sent of  the  Superintendent,  Dr.  Judson  B.  An- 
drews, and  through  him  the  approval  of  the 
Managers,  to  organize  a  course  of  instruction 
for  the  attendants.  The  plan  of  organization 
was  that  of  the  Training  Schools  of  the  general 
hospitals,  with  a  term  of  two  years,  and  gradua- 
tion with  a  certificate  or  diploma.  The  scheme 
was  carried  out  in  all  of  its  details,  and  thus 
the  Training  School  for  Attendants  in  institu- 
tions for  the  insane,  now  found  in  every  asylum 
throughout  the  country,  was  initiated  in  the 
Buffalo  Asylum  for  the  Insane. 


PART  FOUR 

THE  LESSON  APPLIED  TO  THE  IDIOT, 
FEEBLE-MINDED  AND  CRIMINAL 


XX 


Extend  Curative  Methods  to  All  the  Depend- 
ent Classes 


XX 


Extend  Curative  Methods  to  All  the  Depend- 
ent Classes 


HE  lessons  which  the  preceding 
illustrations    of    the    anatomy 
and  physiology  of  the  nervous 
system  teach  have  a  wide  appli- 
cation to  our  treatment  of  the 
dependent  classes.    We    learn 
that   the   mental   attributes   of 
every  person  depend  ultimately  upon  the  phys- 
ical state  of  the  nerve-cell,  over  which  we  have 
almost  absolute  control,  both  in 
The  Lesson      its  individual  and  collective  ca- 
Repeated        pacity.     If  its   texture  is  feeble 
from  heredity  or  disease,  we  may 
make  it  strong  by  nutrition,  exercise,  pure  air, 
and  medication;  if  it  is  undeveloped,  we  can  de- 
velop it  by  applying  its  appropriate  stimulus 
and  suitable  nourishment;  if  it  is  unduly  devel- 
oped and  hence  over-active,  we  can  reduce  it  to 
a  rudimentary  and  inactive  state  by  removing 
every  form  of  stimulant  and  reducing  its  nutri- 
tion; where  neither  the  regulation  of  the  stimu- 

233 


234  WHO   IS   INSANE? 


lant  nor  nutrition  accomplishes  our  purpose,  we 
can  rel}^  upon  specific  remedies. 

The  logical  and  inevitable  conclusion  to  be 
drawn  is  that,  if  we  thoroughly  understood  the 
exact  function  and  the  functional  relations  of 
all  the  cells  of  the  nervous  system,  we  could, 
beginning  with  the  child,  control  in  a  large 
measure  the  development  of  character,  and  in 
the  adult  modify  existing  attributes  by  stimula- 
tion of  one  class  of  nerve-cells  and  the  repres- 
sion of  another  to  any  extent  that  we  desired. 
There  is  no  doubt  that  the  marked  changes 
which  we  often  witness  in  the  mental  attributes 
of  the  sane  and  the  insane,  temporary  and  per- 
manent, are  due  to  temporary  conditions  af- 
fecting the  functional  activity  of  nerve-centres. 
Nothing  can  be  more  thoroughly  practical  than 
the  application  of  the  proper  remedial  meas- 
ures by  which  the  equilibrium  of  these  centres  is 
secured. 

The  superficial  and  mere  surface  knowledge 
of  the  inmates  of  institutions,  on  the  part  of  the 
officers,  not  only  results  in  ignorance  of  the 
possibilities  of  improvement  of  large  numbers 
of  patients,  but  begets  incredulity  as  to  the  ca- 
pacity of  an  entire  class  to  be  improved  by  any 
method  of  treatment.  It  is  equally  true  that  the 
medical  officers,  attendants  and  managers  of 
our  charitable  and  correctional  institutions 
have  little,  and  too  often,  no  faith  in  the  capac- 


WHO   IS   INSANE?  235 


ity  of  the  vast  majority  of  the  mentally  defect- 
ive class  to  be  taught,  the  mentally  diseased 
class  to  be  cured,  or  the  criminal  class  to  be  re- 
formed. And  this  want  of  faith  is  due  to  ig- 
norance of  the  capacities  of  the  human  brain  to 
be  infinitely  modified  by  expert  care. 

THE  result  is  that  no  State  institution,  devoted 
to  the  care  and  treatment  of  these  classes,  is 
so  organized  and  conducted  as  to  be  thoroughly 
curative  in  its  methods.    They  are,  in  fact,  cus- 
todial. In  their  an- 
State  Institutions  nual    reports    they 

Not  Thoroughly  Curative        never    call    special 

attention  to  the  in- 
creasingly large  percentage  successfully  taught, 
cured,  reformed,  and  discharged.  They  do  not 
appear  before  the  Legislatures  asking  appropri- 
ations for  better  facilities  for  teaching  the  idiot, 
curing  the  insane,  and  reforming  the  criminal, 
using  as  an  argument  the  seventy-five  per  cent, 
taught,  cured,  and  reformed  the  past  year,  and 
promising,  with  improved  facilities,  to  raise  the 
p  ^rcentage  tb  ninety-five  per  cent.  On  the  con- 
trary, the  constant  demand  upon  the  State  is  for 
more  buildings  to  accommodate  the  ever-in- 
creasing number  to  be  added  to  the  fixed  popu- 
lation of  these  institutions. 


XXI 


Teach  the  Idiot  and  Feeble-Minded  Self-Care 

AND  SeLF-SuPPORT 


XXI 


Teach  the  Idiot  and  Feeble-Minded  Self-Care 
AND  Self- Support 

IHAT  shall  we  do  "with  the  idiot 
and  the  feeble-minded?    Teach 
them  self -care  and  self-support. 
But  can  they  be  taught?    The 
following  incident  is  an  answer 
to  that  question.     On  a  bright 
summer  day  in  the  early  sixties 
I  took  advantage  of  a  leisure  hour  or  two  in 
Syracuse  to  visit  that  anomaly  among  the  char- 
itable institutions  of  the   State  of 
Educating    New  York,  viz.,  a  school  for  the  in- 
Idiots         struction  of  idiots.     The  very  pur- 
pose of  the  institution — the  educa- 
tion of  idiots — seemed  then  to  be  an  unanswer- 
able argument  against  its  existence.    Its  found- 
er. Dr.  Hervey  B.  Wilbur,  had  encountered  great 
opposition  on  this  very  ground.  No  one  believed 
it  possible  to  teach  idiots  sufficiently  to  make 
the  creation  of  an  institution  for  that  purpose 
justifiable  by  the  Legislature.    The  institution 
finally  took  the  apparently  more  appropriate 

239 


240  WHO   IS   INSANE? 

title,  "The  Custodial  Asylum  for  Feeble- 
Minded." 

While  crossing  the  lawn,  in  my  approach  to 
the  asylum,  I  casually  noticed  a  group  of  young 
men  engaged  in  "making  hay."  Some  were 
mowing,  others  were  spreading  the  cut  grass, 
but  all  were  actively  and  intelligently  at  work. 
On  entering  the  administrative  building  I 
found  Dr.  Wilbur  employed  with  his  daily  du- 
ties. I  introduced  myself  and  explained  that  I 
was  desirous  of  obtaining,  by  personal  observa- 
tion, information  as  to  the  success  of  the  insti- 
tution in  teaching  idiots.  The  doctor's  inter- 
est in  my  visit  was  marked  and  he  became  very 
communicative  in  regard  to  his  work.  We  ex- 
amined every  part  of  the  asylum  and  saw  all 
of  the  inmates  in  their  several  departments  and 
classes.  It  would  be  impossible  to  conceive 
of  an  apparently  more  hopeless  and  repulsive 
task  than  teaching  many  of  those  mere  vegetat- 
ing objects.  Incidentally  I  suggested  the  im- 
possibility of  educating  these  children  to  be- 
come active  and  intelligent  workers  like  the 
you'ng  men  making  hay  on  the  lawn. 

"Why,  my  dear  sir,"  he  replied,  "those  young 
men  are  all  idiots,  but  the  attendant,  whom  I 
presume  you  did  not  recognize  from  the  oth- 
ers; some  of  them  were  as  hopeless  as  the  worst 
you  have  seen  in  the  Asylum." 

I  could  not  conceal  my  skepticism,  and  re- 


WHO   IS   INSANE?  241 

marked  that  I  regarded  it  as  impossible  to  make 
a  first  impression  on  many  of  the  inmates. 

"That  has  been  the  mistake  of  the  world  in 
its  treatment  of  idiots,"  he  replied,  "but  in  these 
later  years  we  have  learned  how  to  teach  the 
first  lesson,  and  on  that  first  lesson  the  whole 
system  of  educating  the  idiot  depends.  Come 
into  the  class  room  and  I  will  give  you  a 
demonstration  of  the  first  lesson  and  its  effects 
and  results." 

WE  went  accordingly  into  the  room  of  the 
lowest  class  of  inmates,  some  of  whom  had 
been  admitted  so  recently  that  the  doctor  knew 
nothing  of  their  physical  or  mental  condition. 
He  requested  me  to  choose  one  of 
The  First      the  latter  class,  who  was  unknown 
Lesson        to  him,  for  a  first  lesson.    I  selected 
a  boy  who  sat  on  the  floor,  drooling 
from  his  open  mouth  and  swaying  his  body,  but 
who  seemed  insensible  to  anything  about  him, 
and,  as  the  attendant  assured  me,  had  to  have 
the  food  placed  in  his  mouth  at  his  meals. 

The  doctor  took  a  dumb-bell,  and  placing  it 
on  the  floor  by  the  side  of  the  boy,  fixed  his 
hand  on  the  shaft  with  the  fingers  closely 
around  it.  Then,  taking  another  dumb-bell, 
and  standing  in  front  of  the  boy,  the  doctor 
raised  his  instrument  high  in  the  air  and  delib- 
erately struck  the  dumb-bell  on  which  the  boy's 


242  WHO   IS   INSANE? 

hand  was  placed.  The  boy  was  startled  by  the 
concussion,  but  made  no  other  sign  of  recogni- 
tion of  the  blow.  The  doctor  repeated  the  act 
twice  more  with  the  same  result. 

"This  is  the  first  lesson,"  the  doctor  re- 
marked, "and  he  is  a  very  promising  student, 
with  great  possibilities.  Now  let  me  show  you 
a  boy  of  the  same  grade  who  has  been  under  in- 
struction for  several  months  with  two  such  les- 
sons daily." 

The  second  boy  was  of  the  type  of  the  first, 
and  on  the  trial  he  removed  his  hand  from  the 
dumb-bell,  when  it  was  struck,  and  raised  his 
eyes  from  the  floor,  as  if  to  see  from  whence 
the  blow  came.  A  third  boy  had  been  under 
treatment  for  a  still  longer  period;  he  watched 
the  doctor's  movements,  and  when  he  saw  the 
blow  descending,  raised  his  hand  and  laughed. 
A  fourth  boy  was  tested,  who  was  now  in  one  of 
the  graded  classes.  When  the  doctor  took  the 
dumb-bell,  and  handed  the  boy  another,  the 
boy  rushed  at  the  doctor  and  for  several  min- 
utes there  was  a  clash  of  weapons,  the  boy 
shov/ing  dexterity  and  immense  enjoyment  of 
the  contest. 

In  the  discussion  of  his  method  of  teaching 
the  feeble-minded  Dr.  Wilbur  laid  great  stress 
upon  the  significance  of  "That  first  lesson." 
His  explanation  was  to  the  effect  that  the  idiot 
had  a  dormant  nervous  system,  and  the  first 


WHO   IS   INSANE?  243 

step  in  the  process  of  educating  him  must 
necessarily  be  to  arouse  the  brain  to  activit}^; 
that  the  best  method  of  making  a  first  impres- 
sion was  through  the  sense  of  feehng;  and  that 
the  shock  communicated  by  a  metalhc  sub- 
stance through  the  sensitive  surface  of  the 
hand  was  the  most  effective  method.  His  ar- 
gument was  this :  If  one  special  sense  of  the  ner- 
vous system  can  be  aroused  to  activity,  other 
special  senses  will  be  excited  secondarily,  and, 
finally,  the  ^hole  brain  will  become  receptive 
of  external  impressions  and  the  higher  mental 
functions  will  be  gradually  developed. 

IN  the  light  of  our  present  knowledge  of  the 
minute  anatomy  of  the  nervous  system  and 
the  physiological  functions  of  its  constituent 
parts.  Dr.  Wilbur's  method  of  teaching  the  idiot 

was  founded  on  strictly 

Interpretation  of  scientific  principles.  Un- 

Dr.  Wilbur's  Method      doubtedly    he    did    not 

understand  the  full  sig- 
nificance of  his  own  reasoning,  for  our  knowl- 
edge of  the  structure  or  minute  anatomy  of  the 
nervous  system  at  that  period  was  little  more 
than  its  gross  appearances.  We  had  learned 
that  its  elements  consisted  of  gray  and  white 
matter;  that  the  gray  matter  was  composed  of 
cells  and  the  white  matter  of  fibres.  The  physi- 
ology of  that  period  taught  us  little  more  than 


244  WHO   IS   INSANE? 

that  the  cells  generated  the  nervous  force,  or 
energy,  and  that  the  fibres,  or  nerves,  conveyed 
impressions,  or  impulses,  to  and  from  the  cells. 
It  quite  naturally  occurred  to  a  thoughtful 
mind  like  Wilbur's  that  the  brain  of  the  idiot 
was  in  an  inert,  or  dormant  state,  owing  to  the 
absence  of  a  stimulus  sufficiently  powerful  to 
arouse  it  to  activity.  If  that  stimulus  could  be 
properly  applied  through  one  of  the  special 
senses — seeing,  hearing,  feeling,  smelling,  tast- 
ing— the  idiot  could  be  taught  like  any  other 
child.  He  chose  the  sense  of  feeling  with  the 
remarkable  results  that  followed.  Had  he 
known  the  full  significance  of  that  first  lesson, 
in  the  light  of  modern  scientific  discoveries  of 
the  intimate  structure  and  functions  of  the  cells 
of  the  brain,  its  immense  number  of  so-called 
centres,  and  their  relations,  his  work  would 
have  been  invested  with  a  new  interest,  and 
there  would  have  been  far  greater  precision  in 
its  execution. 

ALONG  this  line  of  inquiry  as  to  available 
methods  of  stimulating  to  functional  activ- 
ity is  the  proposed  "Electrified  Schoolroom  to 
Brighten  Dull  Pupils,"  of  Nikola  Tesla.     It  is 
well  known  that  eminent  ex- 
Stimulation        perimental    psychologists    be- 
hy  Electricity      lieve    that   the    high-frequency 
current  intensifies  cerebration; 
that  it  is  a  mental  stimulant  like  alcohol,  but  in- 


WHO   IS   INSANE?  245 

stead  of  being  harmful  to  the  brain-cells  as  is 
alcohol,  electricity  is  harmless  and  confers  last- 
ing benefits.  It  is  stated  that  Mr.  Testa's  atten- 
tion was  attracted  to  this  subject  by  noticing  the 
effect  of  electricity  on  one  of  his  assistants  in 
making  certain  high-frequency  tests.  This  as- 
sistant was  very  stupid  in  carrying  out  instruc- 
tions concerning  laboratory  adjustments.  The 
laboratory  was  equipped  with  a  coil  generating 
high  voltage  currents,  and  after  a  time  Mr.  Tesla 
noticed  that  the  man  became  brighter  and  did 
his  work  better,  but  supposed  the  change  was 
due  to  the  assistant's  learning  his  duties  more 
thoroughly.  This  did  not  prove  to  be  the  proper 
explanation.  On  observing  the  actions  of  the 
man  more  closely  he  concluded  that  his  assist- 
ant's increased  aptness  and  alertness  were  due 
to  a  much  deeper  cause  than  mere  experience; 
that  the  elements  of  "mental  life" — the  brain 
cells — had  been  stimulated  to  greater  functional 
activity. 

This  new,  novel,  and  practical  method  of 
awakening  to  activity  dormant  brain  cells  has 
been  subjected  to  trial  on  a  large  scale  in 
Stockholm,  Sweden.  Two  sets  of  fifty  children 
each,  averaging  the  same  age  and  physical  con- 
dition, were  placed  in  separate  classrooms 
exactly  alike  except  for  the  concealed 
wires  in  one  of  the  rooms.  The  regu- 
lar   school    work    was    pursued    and    the    test 


246  WHO   IS   INSANE? 


lasted  for  six  months.  The  result  recorded  was 
as  follows:  The  children  in  the  magnetized 
room  increased  in  stature  two  and  a  half  inches; 
those  in  the  unmagnetized  room  increased  one 
and  one-fourth  inches;  the  former  also  showed 
an  increase  in  weight  and  physical  develop- 
ment greater  than  the  latter.  More  remarkable 
was  the  difference  between  the  mental  devel- 
opment of  the  two  classes,  viz. :  Those  exposed 
to  the  electric  waves  averaged  ninety-two  per 
cent,  in  their  school  work,  compared  with  an 
average  of  seventy-two  per  cent,  of  the  children 
in  the  other  room;  fifteen  pupils  in  the  elec- 
trified room  were  marked  100,  and  nine  in  the 
other  class.  It  is  stated  in  the  report  that  the 
electrified  children  appeared  generally  more 
active  and  less  subject  to  fatigue  than  those  not 
electrified,  and  that  the  teachers  experienced 
a  quickening  of  the  faculties  and  an  increase 
of  endurance. 

The  method  of  applying  the  electricity  was 
thus  stated:  Carefully  insulated  wires  were  in- 
serted in  the  walls  of  the  experimenting  class- 
room and  the  test  was  carried  on  without  the 
knowledge  of  either  the  teacher  or  the  pupils; 
the  air  of  the  room  was  completely  saturated 
with  incalculable  millions  of  infinitesimal  elec- 
tric waves  vibrating  at  a  frequency  so  great  as 
to  be  unimaginable  and  capable  of  measure- 
ment only  by  a  most  delicate  voltmeter. 


XXII 

The  Treatment  of  the  Criminal 


XXII 

The  Treatment  of  the  Crimenal 

HAT  shall  we  do  with  the  crim- 
inal?   Reform  himt — form  him 
anew — ^is  the  answer  of  modern 
physiology.  The  problem  is  the 
same  as  that  of  curing  the  in- 
sane, viz.,  the  reforming  or  re- 
adjusting of  a  deranged  mech- 
anism.    Certain  nerve-centres  have  been  over- 
stimulated  and  thus  enlarged  until  their  func- 
tional activity  has  controlled  the 
Reform  the       thoughts,   purposes   and   acts   of 
Criminal        the  individual  precisely  as  in  the 
case  of  the  insane.    The  cure  of 
the  insane  and  the  reform  of  the  criminal  are, 
therefore,  closely  allied  problems,  the  solution 
of  which  depends  upon  our  ability,  in  either 
case,  to  repress  the  abnormal  activity  of  nerve- 
centres,    which    incite    to    criminal    acts,    and 
arouse  to  activity  dormant  nerve-centres  which 
counteract  or  inhibit  the  action  of  the  former. 
The  reform  of  the  criminal,  the  cure  of  the  in- 
sane and  idiot  are  purely  physiological  ques- 

249 


250  WHO  IS   INSANE? 

tions,  and  the  policy  of  the  State  in  its  care  and 
treatment  of  these  classes  should  be  in  strict 
conformity  therewith. 

The  International  Prison  Congress,  at  its 
session  at  Washington,  D.  C,  in  1910,  placed  on 
record  the  following  resolution,  which  embodies 
the  opinions  of  the  most  advanced  students  of 
penology,  the  experience  of  practical  workers 
in  prisons,  and  a  fundamental  principle  of 
physiology:  "No  prisoner,  no  matter  what  his 
age  or  past  record,  should  be  assumed  to  be  in- 
capable of  improvement." 

From  a  physiological  view-point  what  are  the 
best  methods  of  re-forming  the  criminal?  Cen- 
turies of  experience  have  proven  that  the  puni- 
tive method,  embodying  the  Mosaic  "eye-for- 
an-eye"  idea  of  justice,  and  which  must  have 
originated  in  our  animal  ancestry,  has  not  an 
element  of  reform  in  its  practical  details. 

PHYSICAL  torture  by  various  methods  may 
compel  compliance  with  prison  rules,  but  it 
only  arouses  to  greater  activity  the  brain-cen- 
tres which  incited  to  crime.     Solitary  confine- 
ment in  a  dark  cell,  and  a  diet 
The  Effect  of        of  bread  and  water  enforced 
the  Old  Method      upon  a  person  trained  from 

infancy  in  vice  and  crime, 
combined  with  the  cold,  harsh,  repellant  treat- 
ment which  he  daily  receives  from  officers  and 


WHO   IS   INSANE?  251 

attendants,  excite  to  intense  activity  every  vi- 
cious nerve-centre.  When  his  term  of  impris- 
onment expires  he  leaves  the  prison,  not  a  re- 
formed, a  made-anew  man,  but  a  confirmed 
criminal,  prepared  by  long  reflection  for  a  more 
enlarged  field  of  crime.  The  punitive  method 
of  reforming  the  criminal  is  not  the  physiolog- 
ical method,  for  instead  of  repressing  the  activ- 
ity of  the  vicious  nerve-centres,  and  awakening 
to  activity  the  virtuous  nerve-centres,  it  has  a 
contrary  effect,  and  makes  the  criminal  ten-fold 
more  undesirable  as  a  citizen  than  before  the 
State  attempted  his  reform. 

Socrates  was  asked  how  a  vicious  boy  could 
be  reformed,  and  he  replied:  "Remove  every 
possible  incitement  to  vice,  and  substitute  every 
possible  incitement  to  virtue"  The  Athenian 
philosopher  formulated  his  maxim  on  a  sound, 
physiological  basis.  The  aim  of  the  physiolog- 
ical treatment  of  the  criminal  is,  first,  to  secure 
him  sound  physical  health;  and,  second,  to  di- 
vert his  thoughts  from  his  former  evil  associates 
and  associations,  and  to  concentrate  them 
upon  objects  which  promote  virtuous  acts  and 
tend  to  create  a  desire  and  an  impulse  to  lead 
a  better  life  in  the  future. 

The  physiological  effect  of  this  treatment  is 
that  long  active  nerve-centres,  which  incited  to 
vice  and  crime  and  dominated  the  mental  op- 
erations of  the  individual,  fall  into  a  state  of 


252  WHO  IS  INSANE? 


desuetude,  and  the  long  dormant  nerve-centres, 
which  incite  to  virtuous  acts,  are  aroused  to 
activity  and  assume  complete  control  of  the 
thoughts  and  acts.  The  criminal  is  thus  re- 
formed— made  anew. 

Practically,  the  prison  becomes  a  school  and 
the  term  of  service  depends  upon  the  progress 
which  the  inmate  has  made  in  the  course  of 
training  to  which  he  was  assigned  on  entering 
the  institution.  The  final  test  would  be  a  pa- 
role. Discharge,  or  graduation,  would  depend 
upon  the  evidence  of  reform,  or,  in  the  language 
of  the  schools,  upon  his  having  "satisfactorily 
passed  a  final  examination." 

THIS  view  of  the  treatment  of  the  criminal,  as 
the  proper  State  policy,  is  no  longer  a  theory 
but  a  practical  fact,  demonstrated  in  the  most 
luminous  manner  both  in  Europe  and  in  the 

United  States.  No  argu- 
The  New  Method  ment  for  the  policy  of  yq,- 
in  Demonstration        forming   the   criminal   by 

physiological  process  can 
be  adduced  that  has  the  convincing  power  of  the 
narrated  experience  and  opinion  of  those  who 
have  instituted  the  new  method. 

"I  do  not  wish  to  know  anything  about  your 
past  life.  When  you  entered  the  gate  of  this  in- 
stitution you  left  your  past  life  behind  you;  my 
interest  in  you  is  as  to  your  future  life."    Such 


WHO   IS   INSANE?  253 

was  the  answer  of  Mrs.  Johnson,  of  the  Prison 
for  Women,  Massachusetts,  to  the  threat  of  a 
young  woman  convict  whom  the  trial  Judge  at 
Boston  declared  to  have  the  most  desperate 
criminal  record  ever  known  to  that  court.  When 
Mrs.  Johnson,  as  Superintendent,  made  her  first 
visit,  as  usual  alone,  to  the  cell  of  the  recently- 
admitted  convict,  she  was  accosted  with  this  re- 
mark :  "You  would  not  dare  to  visit  me  alone  if 
you  knew  my  history;  I  have  been  in  all  the  pris- 
ons of  Ireland  and  in  most  in  this  country,  even 
in  Joliet;  I  have  killed  my  man,  too,  and  you  had 
better  take  warning." 

Mrs.  Johnson's  reply,  "When  you  entered  the 
gate  of  this  institution  you  left  your  past  life 
behind  you,"  was  the  key-note  to  her  remarka- 
ble success  in  reforming  criminal  women.  Ev- 
ery possible  effort  was  made  to  effectually  close 
the  past  life  of  crime  and  begin  a  life  of  virtue, 
— that  is,  to  repress  and  reduce  to  their  rudi- 
mentary state  the  vicious  nerve-centres  and 
awaken  to  the  most  intense  activity  possible  the 
virtuous  nerve-centres.  To  this  end  the  institu- 
tion, with  its  farm,  was  supplied  with  every 
needed  facility  for  in-  and  out-door  occupa- 
tion and  diversion.  No  inmate  was  allowed  to 
be  idle,  and  each  was  stimulated  to  the  per- 
formance of  some  form  of  active  duty  by  the 
agreeable  nature  of  that  duty  or  by  the  desire  to 
win  a  higher  position  in  the  established  grades. 


254  WHO   IS   INSANE? 


"Truth  and  Trust"  was  the  symbol  of  the 
highest  grade,  and  those  who  attained  to  it  were 
privileged  to  wear  a  white  jacket  with  the  let- 
ters "T  &  T"  on  the  lapel.  The  desperate  crim- 
inal, the  young  Irish  woman  to  whom  we  have 
referred,  not  only  attained  to  the  highest  grade 
but  returned  to  her  home  in  Ireland,  and  seven 
years  after  her  discharge  the  priest  of  the  par- 
ish wrote  Mrs.  Johnson:  "Sarah  is  my  main 
reliance  in  the  efforts  of  our  church  to  redeem 
the  wayward  and  vicious  young  people  of  the 
parish." 

Mrs.  Johnson  had  the  most  absolute  confi- 
dence in  her  ability  to  reform  the  most  incorri- 
gible criminal  woman  by  the  simple  method  of 
obliterating  the  past  life  of  vice  and  crime  by 
occupation,  diversion,  truth  and  trust.  To  an 
officer  of  the  State  Government,  who  cautioned 
her  not  to  be  alone  with  a  woman  criminal  who 
was  homicidal  and  hopeless  as  to  reform,  she 
replied :  "This  prison  is  intended  for  that  very 
class  of  convict  women;  visit  it  in  one  year,  and 
if  that  woman  is  not  in  your  opinion  reformed, 
I  will  abandon  the  institution."  He  had  no  con- 
fidence in  her  work  and  did  not  visit  the  prison, 
but  the  woman  was  reformed,  was  married  to 
a  prominent  Justice,  and  became  the  mother  of 
a  family  which  holds  a  high  social  position  in 
a  western  community. 

In  passing  through  the  institution,  objects  for 


WHO   IS   INSANE?  255 

study  and  diversion  were  met  on  every  hand. 
In  one  inclosure  was  a  pet  horse,  in  another 
several  sheep  and  lambs,  in  a  third  chickens,  in 
a  fourth  geese,  in  a  fifth  pigs.  Each  animal  had 
a  pet  name,  given  by  the  inmates,  and  all  were 
tame,  owing  to  the  constant  fondling  by  the 
patients. 

CONTRAST  two  reformatory  institutions,  in 
one  of  which  the  discipline  was  by  punitive, 
and  in  the  other  by  physiological  methods.    In 
the  first  Reformatory  three  methods  of  punish- 
ment were  adopted,  according 
The  Old  and  New  to  the  grade  of  offense,  viz., 
in  Contrast       confinement   in    a    dark    cell 
with  bread   and  water   as   a 
diet;  standing  at  the  door  of  the  cell  with  the 
hands  raised  to  the  full  length  of  the  arms  and 
chained  in  that  position   during  the  ordinary 
working  hours;  spanking  with  a  large  and  heavy 
leather  strap. 

An  examination  of  a  large  number  of  the  in- 
mates who  had  suffered  these  forms  of  pun- 
ishment gave  the  following  results.  Those  who 
had  been  subjected  to  solitary  confinement  and 
a  diet  of  bread  and  water  were  generally  so  well 
satisfied  with  their  treatment  that  the  Superin- 
tendent complained  of  their  unwillingness  to  re- 
turn to  work  even  after  sixty  days'  confinement. 
An  examination  of  these  offenders  readily  ex- 


256  WHO   IS   INSANE? 


plained,  physiologically,  what  the  Superintend- 
ent regarded  as  evidence  of  their  incorrigibility. 
First,  darkness  and  quiet  induced  sleep  and  they 
enjoyed  the  undisturbed  repose.  Second,  bread 
and  water  as  a  diet,  with  complete  physical  rest, 
soon  destroyed  all  demand  and  appetite  for 
food,  which  resulted  in  a  general  deterioration 
of  brain,  muscle,  heart,  and,  indeed,  of  all  the 
organs  and  tissues.  The  punished  inmate  was 
in  the  condition  of  a  hibernating  animal.  When 
he  finally  returned  to  his  work  he  was  feeble  in 
health,  morose  in  temper,  and  far  more  incorri- 
gible than  before  his  punishment. 

The  offenders  who  had  to  submit  to  spanking 
and  being  chained  by  the  hands  raised  over  the 
head  were  hostile  towards  the  officers,  threat- 
ening and  unmanageable.  The  atmosphere  of 
the  entire  Reformatory  was  charged  with  the 
hatred  and  antagonism  which  existed  between 
the  officers  and  the  prisoners.  Scarcely  a  word 
was  spoken  to  the  latter  by  the  former,  except  in 
tones  of  command.  Not  a  smile  was  seen  on  the 
faces  of  the  inmates,  but  many  a  contemptuous 
glance  was  noticed  as  an  officer  passed. 

Now  let  us  study  the  obverse  side  of  this  pic- 
ture, in  a  Reformatory  where  the  discipline  is 
based  on  strictly  physiological  and  psycholog- 
ical principles.  The  Superintendent  was  asked: 
"What  is  your  method  of  disciplining  an  inmate 
who  throws  down  his  tools  and  declares  he  will 
not  work?"    The  reply  was,  in  substance: 


WHO   IS   INSANE?  257 

"We  regard  such  an  inmate  ias  a  mere  crank 
who  wishes  to  make  the  other  men  of  the  class 
feel  his  importance.  He  is  at  once  advised  that 
he  may  leave  his  class  and  go  to  a  certain  room 
— one  of  a  number  made  purposely  for  the  dis- 
cipline of  offenders — and  have  a  rest.  These 
rooms  are  one  story,  of  small  size,  and  the  roof 
is  made  of  glass.  The  furniture  is  a  cot  and 
stool.  The  room  is  intensely  lighted,  owing  to 
the  glass  ceiling.  The  rebellious  prisoner  with- 
draws from  the  gang  with  a  defiant  air  and  en- 
ters his  rest-room.  His  first  impulse  is  to  throw 
himself  on  his  cot  and  sleep,  but  the  glare  of 
light  is  so  great  that  he  cannot  sleep.  He  sits 
upon  the  stool,  but  it  soon  becomes  uncomforta- 
ble and  he  takes  to  walking.  He  soon  tires  of 
that  and  repeats  his  efforts  to  sleep,  but  again 
fails  owing  to  the  light,  and  thus  the  day  passes 
with  alternate  efforts  to  secure  rest  by  lying  on 
the  cot,  sitting  on  the  stool,  and  walking. 

"His  meals  are  regularly  served,  and  they  are 
composed  of  the  richest  and  most  stimulating 
foods.  Such  a  diet  greatly  aggravates  his  rest- 
lessness and  increases  his  discomfort.  Within 
three  days,  as  a  rule,  the  most  obstinate  offender 
intimates  that  he  would  be  willing  to  resume 
his  work,  but  the  Superintendent,  who  visits  him 
daily,  very  kindly  suggests  that  as  he  was  so  ex- 
hausted with  his  work  he  had  better  take  a  good 
rest,  and  adds  the  humiliating  statement  that 


258  WHO  IS  msANE? 


the  fellows  in  his  class  had  requested  that  he  be 
not  associated  with  them  again  as  they  did  not 
like  him." 

It  is  a  fact  of  record  in  this  Reformatory  that 
incorrigible  prisoners  rarely  remained  in  seclu- 
sion more  than  five  days,  and,  when  they  re- 
turned to  work  were  strong  and  vigorous,  hum- 
bled, because  they  did  not  prove  to  be  heroes  in 
the  opinions  of  their  fellows,  and  grateful  to  the 
officers  who  had  treated  them  so  humanely. 
The  visitor  to  that  Reformatory  is  surprised  at 
the  familiarity  between  the  officers  and  the 
prisoners,  and  at  the  smiling  faces  of  the  latter 
as  the  former  pass  through  the  different  depart- 
ments, speaking  freely  with  them,  calling  them 
by  name,  and  often  giving  them  friendly  taps  on 
the  shoulders. 

Can  there  be  any  doubt  which  of  these  Re- 
formatories discharged  the  greater  number  of 
permanently  reformed  criminals?  Of  a  large 
number  interviewed,  who  had  been  treated  by 
the  punitive  method,  all  condemned  it,  and  none 
admitted  that  he^was  induced  to  change  his  vi- 
cious habits  by  his  punishments;  while  those  dis- 
charged from  the  Reformatory  where  rational, 
humane  and  physiological  methods  were  prac- 
ticed, referred  to  their  treatment  in  terms  of 
gratitude  for  its  effect  in  changing  their  vicious 
tendencies  and  giving  them  new  and  better 
views  of  life. 


WHO   IS   INSANE?  259 

It  is  gratifying  to  have  on  record  practical 
proofs  that  the  humane  treatment  of  criminals 
should  now  become  the  policy  of  States,  not  only 
because  of  its  reformatory  tendencies,  but  also 
because  of  its  economical  results. 

"The  State  of  Vermont,"  says  a  recent  writer, 
"contains  a  prison  where  the  inmates  are 
treated  upon  a  novel  plan.  They  are  trusted 
and  treated  like  other  human  beings;  they  come 
and  go  almost  as  freely  as  the  members  of  the 
jailor's  own  family;  so  far  as  possible,  whatever 
suggests  punishment  or  disgrace  is  banished; 
and  they  are  made  to  feel  that  their  imprison- 
ment is  designed  to  improve  them  as  men,  and 
to  restore  them  to  social  life  not  only  with  full 
self-respect  but  with  the  cordial  respect  of  the 
community." 

THIS  is  the  physiological  idea  of  re-forming 
— creating  anew, — the  brain  of  a  criminal, 
tersely  and  accurately  stated.  The  conditions 
under  which  he  is  placed  when  he  enters  upon 

his  prison  career  all  tend  to 
The  New  Method     repress    the    vicious    nerve- 
in  Vermont  centres    and    to    arouse    to 

healthy  activity  the  virtuous 
nerve-centres.  The  success  of  this  treatment  has 
happily  had  a  secondary  effect  upon  the  preju- 
dices of  the  people.  The  writer  adds :  "In  Mont- 
pelier,  where  this  prison  stands,  the  inveterate 


260  WHO   IS   INSANE? 


prejudice  against  prisoners  has  been  swept 
away.  So  great  is  the  significance  of  this 
achievement,  denoting  as  it  does  a  reversal  of 
popular  sentiment  toward  the  criminal,  that 
only  something  approaching  a  revolution  in  the 
prison  system  itself  could  have  produced  it." 

It  is  an  interesting  fact  that  in  establishing  the 
new  or  physiological  system  of  treating  crimi- 
nals, the  Sheriff  of  the  county  in  which  Mont- 
pelier  is  located  was  not  actuated  by  the  results 
of  scientific  study  but  merely  followed  the  sug- 
gestions of  his  own  common  sense.  There  was  a 
State  law  that  provided :  "A  male  prisoner  im- 
prisoned in  a  county  jail  for  being  found  intoxi- 
cated, for  a  breach  of  the  peace,  or  for  being  a 
tramp,  may  be  required  to  perform  not  more 
than  ten  hours  of  manual  labor  within  or  with- 
out the  walls  of  such  county  jail  each  day  of 
such  imprisonment,  except  on  Sundays  or  on 
legal  holidays."  The  object  of  this  law  was  to 
utilize  the  labor  of  the  prisoners  in  the  interests 
of  the  State  for  economic  rather  than  reforma- 
tory purposes. 

When  the  Sheriff  was  questioned  as  to  his  mo- 
tives in  making  this  larger  application  of  the  law 
to  the  regeneration  of  the  prisoner,  he  replied: 
"I  thought  of  each  prisoner  as  having  a  parent 
with  the  feelings  and  hopes  for  him  that  mine 
had  for  me,  and  reflected  that  if  the  prisoners 
had  grown  up  in  the  absence  of  such  an  influ- 


WHO  IS  mSANE?  261 

ence,  they  had  been  defrauded,  and  deserved 
only  compassion,  not  blame,  for  sinking  into 
jail."  This  is  the  new  spirit  which  is  to  govern 
in  the  enforcement  of  our  penal  laws. 

When  the  Sheriff  began  his  new  method  he 
had  no  other  plan  than  that  of  treating  the  pris- 
oners humanely  and  awakening  in  their  minds 
a  feeling  of  trust  and  hence  of  respectability. 
But  his  first  efforts,  those  of  finding  employ- 
ment for  them  among  business  men,  proved  a 
failure.  "No  one  would  have  them;  the  sane 
and  safe  business  men  were  not  to  be  taken  in 
like  that;  they  comforted  him  with  assurances 
that  he  must  fail — the  same  business  men  who 
now  send  regularly  to  him  for  workers  when 
they  want  help,  in  preference  to  picking  men  up 
on  the  street." 

THE  secret  of  success  was  revealed  when  the 
Sheriff  attempted  to  employ  the  prisoners 
on  his  own  farm.  He  allowed  the  State  fifty 
cents  a  day  for  each,  but  paid  the  men  nothing. 

The  experiment  was  a  failure,  as 
The  Secret  the  prisoners  did  little  and  poor 
of  Success        work.    It  is  reported  that,  "One 

day,  much  discouraged,  the  Sher- 
iff called  one  of  the  group  into  his  office  for  a 
heart-to-heart  talk,  asking  him  to  say  frankly 
why  he  did  not  do  more.  'I'm  doing  just  as  lit- 
tle as  I  can  and  not  be  punished,  and  I'm  going 


262  WHO   IS   INSANE? 

to  keep  on.  You  would  do  the  same,'  answered 
the  man."  The  Sheriff  was  impressed  with  the 
reply,  and,  imagining  himself  in  the  prisoner's 
place,  recognized  the  truth  of  the  remark,  "You 
would  do  the  same."  A  day's  work  and  nothing 
for  it!    What  incentive  had  he  to  labor? 

"If  you  could  have  seventy-five  cents  for 
yourself  from  your  work  each  day,  what  would 
you  do  ?"  inquired  the  Sheriff  of  a  prisoner  who 
failed  to  do  his  allotted  work.  "Try  me,"  was 
the  answer.  The  next  day  this  "incorrigibly  ob- 
stinate idler,  while  there  was  no  incentive," 
worked  as  well  as  any  free  man  in  the  gang. 

The  Montpelier  jail  was  a  success  from  the 
moment  the  Sheriff  received  the  pertinent  an- 
swer, "You  would  do  the  same,"  and  the  prompt 
challenge,  "Try  me."  This  suggested  the  plan 
of  organization  of  the  jail  as  follows:  "One 
dollar  a  day  is  set  aside  from  the  wages  of  each 
for  the  State,  while  all  in  excess  of  that  belongs 
to  the  earner.  As  it  works  out  in  figures,  every 
man  in  ordinary  health  earns  the  full  laborer's 
pay  of  $1.75  a  day,  of  which  seventy-five  cents 
is  his,  the  Sheriff  acting  as  his  banker  and  keep- 
ing the  acumulation  until  he  leaves  the  prison, 
when  it  is  given  to  him  in  a  lump  sum." 

The  financial  results  of  the  humane  method 
of  treating  criminals  are  thus  stated:  "The  prof- 
its accruing  to  the  State  have  steadily  increased. 
At  the  end  of  the  first  year  they  were  $200;  of 


WHO   IS   INSANE?  263 

the  second,  $500;  of  the  third,  $1,000;  after  hav- 
ing paid  for  all  clothing,  tools  and  supervision 
in  the  form  of  keeping  the  books  and  other  cler- 
ical work.  At  the  close  of  the  fourth  year  . 
the  gross  earnings  for  the  State  were  over  $1,800. 
Since  an  amount  equal  to  three-fourths  of  this 
was  retained  by  the  men,  their  share  was  more 
than  $1,350.  .  .  .  During  the  whole  period 
their  labor  earned  above  $6,000,  of  which  a  total 
exceeding  $2,600  was  kept  by  themselves.  As  a 
rule  the  men  have  carefully  saved  their  money, 
limiting  permitted  purchases  for  themselves  to 
send  it  home  to  those  dependent  on  them." 

THE  writer  says  that,  brilliant  as  has  been  the 
financial  success  of  the  new  system,  this  "is 
but  a  small  part  of  the  good  it  accomplishes;  its 
real  value  is  to  be  measured  by  its  effect  upon 
the  characters  and  lives  of  the 
The  Effect        prisoners.    They  leave  the  jail 
on  Character     rugged   and   healthy   from    the 
sane  and  vigorous  existence  they 
have  led  while  there.    Their  habits  have  been 
regular,  they  have  been  daily  in  the  open  air 
when  work  could  be  had,  their  food  has  been 
substantial,  the  atmosphere  in  which  they  lived 
salutary." 

Speaking  of  his  visit  to  the  Montpelier  jail  the 
writer  says :  "I  spent  the  greater  part  of  a  day 
talking  with  the  prisoners,  first  in  company  with 


264  WHO   IS   INSANE? 

the  deputy  sheriff,  and  then  alone,  with  full  per- 
mission to  discover  opposition  to  the  manage- 
ment if  I  could.  In  this  way  I  made  the  personal 
acquaintance  of  the  men.  Later,  on  the  main 
street  of  the  city,  whom  should  I  meet  but  five 
or  six  of  these  very  prisoners,  walking  along 
with  smiling  faces  and  a  happy  air,  no  more  re- 
sembling the  conventional  criminal  than  did  the 
merchants,  workingmen,  and  lawyers  with 
whom  they  mingled. 

"Here  was  one  of  the  keys  to  the  mystery.  No 
officer  was  about,  keeping  an  eye  on  them;  no 
peculiarity  of  clothing  indicated  who  they  were; 
they  were  free  to  walk  off  if  they  pleased,  and 
no  one  at  the  jail  was  worrying  about  them;  and, 
best  of  all,  the  citizens  of  Montpelier,  who  knew 
perfectly  well  that  inmates  of  the  county  prison 
were  at  all  times  of  the  day  and  evening  at  large 
in  their  midst,  were  worrying  no  more  about  it 
than  were  the  sheriff  and  his  assistants  them- 
selves. 

"And  yet,  four  years  ago,  when  the  system  was 
first  put  into  operation,  a  very  decided  tremor 
convulsed  these  very  citizens.  They  were  ani- 
mated by  all  the  righteous  dread  and  abhor- 
rence of  the  inhabitants  of  jails  common  to  or- 
dinary mankind.  They  believed  that  the  men 
were  dangerous,  that  they  would  run  away,  that 
it  was  treating  them  on  wrong  principles  to  give 
them  such  freedom,  and  that  it  was  a  disgrace 


WHO  IS   INSANE?  265 

to  good  people  to  have  criminals  going  about 
unguarded  on  the  same  streets.  But  if  you  sug- 
gest these  ancient  and  wholesome  ideas  to  a 
Montpelier  man  now,  he  laughs  at  you;  he  is 
ashamed  that  four  years  ago  he  entertained 
such  superstitions. 

"It  appears  that  the  Sheriff  who  inaugurated 
the  new  plan  of  treating  prisoners  was  himself 
so  much  in  doubt  as  to  its  practicability  that  for 
a  time,  when  the  men  did  not  return  promptly 
to  the  jail  at  the  appointed  time,  he  became  ner- 
vous and  walked  the  streets  in  search  of  them. 
But  that  is  all  past  now,  not  only  because  of  the 
unsuspected  traits  of  human  nature  that  expe- 
rience has  unfolded,  but  because  of  the  marvel- 
ous practical  success  of  the  system.  During  the 
four  years,  out  of  eight  hundred  prisoners  treat- 
ed upon  the  new  plan  only  two  attempted  to 
escape,  both  of  whom  were  recaptured  and  sen- 
tenced to  long  terms  in  the  House  of  Correction 
for  betraying  the  trust  reposed  in  them.  With 
such  a  record  as  this  the  Sheriff  no  longer  feels 
perturbed  if  his  entire  corps  of  prisoners  is  scat- 
tered in  every  direction  during  the  day;  and  he 
is  perfectly  assured  that  at  night  they  will  reap- 
pear at  the  jail." 

An  instance  is  given  of  the  trust  reposed  in 
the  prisoners.  The  Sheriff  purchased  tickets  to 
a  circus  for  as  many  as  desired  to  go,  and  sent 
them  unattended.    Eleven  went,  others  refusing 


266  WHO   IS   INSANE? 


because  they  were  working  for  farmers  and  pre- 
ferred the  money  which  they  were  earning.  The 
opportunity  to  escape  was  excellent,  as  the  per- 
formance continued  until  after  dark;  yet  every 
one  of  them  was  at  the  jail  fifteen  minutes  after 
the  tent  closed,  though  some  of  the  men  had 
long-term  sentences. 


PART  FIVE 

A  NEW  INSTITUTION— THE  DAWN  OF  A 
BETTER  DAY 


XXIII 
A  New  Institution 


XXIII 

A  New  Institution 

T  is  gratifying  to  notice  the  trend 
of  thought  and  effort  of  the 
more  advanced  students  of  so- 
cial science  to  practically  apply 
the  teachings  of  physiology  to 
the  curative  treatment  of  the  in- 
sane, the  idiot  and  the  criminal. 
We  must  recognize  in  the  Psychopathic  Hos- 
pitals, the  Schools  for  the  Education  of  the  Fee- 

ble-Minded  Children,  the 

Enlightened         Training  Schools  for  Girls  and 

Public  Policy        Boys,  and  similar  institutions, 

the  beginning  of  a  far  more 
enlightened  public  policy  in  the  care  of  these 
classes. 

An  institution  that  will  more  nearly  realize 
the  ideal  standard  of  treatment  on  admission  to 
State  care,  which  physiological  and  psycholog- 
ical science  demands,  is  the  organization  at  the 
New  York  State  Reformatory  for  Women,  Bed- 
ford Hills,  Westchester  County,  under  the  title 
of  the  Bureau  of  Social  Science. 

271 


272  WHO  IS  msANE? 

This  Bureau  had  its  origin  in  a  discussion 
between  a  Committee  on  Criminal  Courts  in 
New  York  City,  the  City  Magistrates  of  that  city, 
and  the  Managers  and  officers  of  the  Bedford 
Reformatory.  The  Magistrates  stated  that  it 
was  often  difficult  to  determine  what  to  do  with 
specific  cases  which  came  before  them;  the  mere 
appearance  of  a  young  woman  in  court  did  not 
furnish  sufficient  opportunity  to  form  a  correct 
judgment  of  her  mental  characteristics;  even  in 
cases  where  the  probation  officer  investigates 
the  facts  in  the  life  of  individuals,  she  cannot  in 
the  short  time  allotted  her  obtain  the  informa- 
tion necessary  to  enable  the  committing  magis- 
trate to  decide  unerringly  to  what  institution 
each  prisoner  should  be  sent.  How  can  this  de- 
fective system  of  administering  justice  be  rem- 
edied? 

What  possible  reply  to  the  appeal  of  the  Mag- 
istrates could  be  more  rational,  in  the  light  of 
our  preceding  studies,  than  that  of  the  Managers 
which  was,  in  substance,  "After  conviction  and 
before  sentence  have  the  entire  life-history 
of  the  convict — heredity,  diseases,  education,  en- 
vironment, habits,  social  relations,  mental  pe- 
culiarities, present  health,  predisposing  and  ex- 
citing cause  of  the  crime — investigated  and  then 
you  can  determine  with  scientific  precision  what 
course  must  be  pursued  to  effect  her  reform." 
Here,  in  a  single  paragraph,  the  basic  principle 


WHO   IS   INSANE?  273 


of  a  correct  public  policy  in  the  treatment  of  the 
dependent  classes  is  stated.  In  medical  terms 
the  statement  would  have  been  thus,  "Make  a 
correct  diagnosis  of  the  case  before  you  decide 
the  course  of  treatment  adapted  to  effect  a 
cure." 

The  germ  in  the  question  put  by  the  Magis- 
trates fell  in  good  ground.  The  management  of 
the  Bedford  Reformatory  had  already  instituted 
a  course  of  investigation  of  the  life-history  of 
some  of  its  inmates  by  a  skilled  psychopathist 
for  the  purpose  of  being  able  to  determine  more 
intelligently  the  course  of  treatment  best  adapted 
in  each  case  to  effect  reform.  In  this  ques- 
tion came  the  opportunity  of  enlarging  and  per- 
fecting their  scheme  of  reform  in  their  work. 

THE  managers  formulated  a  plan  that 
would  give  effect  practically  td  their  ideas, 
which  was  submitted  to  the  Committee  on  Crim- 
inal Courts.  The  Committee  gave  the  plan  wide 
circulation  among  the  magistrates 
A  New  Plan  and  philanthropic  citizens,  many 
Formulated  of  whom  approved  it  but  re- 
garded it  impracticable  as  a  pub- 
lic measure  owing  to  the  expense  attending  its 
installation,  and  its  revolutionary  character. 
Fortunately  the  plan  came  to  the  notice  of  sev- 
eral interested  persons  able  and  willing  to  fi- 
nance the  undertaking,  and  its  success  was  as- 


274  WHO  IS   INSANE? 

sured.  An  organization  was  formed  and  incor- 
porated under  the  above  title — The  Bureau  of 
Social  Science. 

The  details  of  the  plan  of  organization  finally 
adopted  are  worthy  of  record,  for  they  may  be 
suggestive  to  those  who  undertake  the  establish- 
ment of  similar  institutions.  The  object  sought 
was  to  create,  in  immediate  connection  with  the 
Bedford  Reformatory,  a  Bureau  or  Department 
devoted  to  the  thorough  study  of  every  woman 
convicted  of  crime  and  sent  to  the  Reformatory 
by  the  magistrates  of  New  York  City  in  order  to 
determine,  before  she  is  admitted  to  the  Reform- 
atory, the  kind  of  treatment  she  should  receive 
to  effect  her  reform.  While  the  Bureau  is  to  be 
under  the  jurisdiction  and  immediate  control  of 
the  Managers  of  the  Reformatory,  it  is  not  lo- 
cated within  the  grounds  of  that  institution  but 
on  a  separate  tract  of  land,  equipped  by  build- 
ings, industries  and  means  for  occupation  and 
diversion  adapted  to  the  application  of  every 
test  necessary  to  determine  the  physical,  mental 
and  moral  peculiarities  of  the  individual. 

The  relation  of  the  promoters  of  the  Bureau 
and  the  Managers  of  the  Reformatory  to  the  new 
institution  is  as  follows :  "As  the  Bureau  is  re- 
garded as  an  experiment,  the  expense  of  which 
the  State  would  not  assume,  the  promoters  un- 
dertake to  finance  this  feature  of  the  operations 
of  the  Bureau,  and  the  Managers  assume  only 


WHO  IS   INSANE?  275 

the  expense  ordinarily  incurred  in  the  care  of 
the  same  inmates  in  the  Reformatory.  Thus  the 
promoters  purchase  the  land,  build  the  build- 
ings, equip  the  laboratories,  and  pay  the  salaries 
of  the  Research  Staff,  while  the  Managers  fur- 
nish the  ordinary  supplies,  attendants  and 
workers." 

THERE  are  to  be  three  Departments  of  inves- 
tigation, viz..  Medical,  Physiological  and  So- 
ciological. Each  Department  is  to  be  in  charge 
of  skilled  and  experienced  experts  and  to  be 

equipped  with  every  device  neces- 
Three  Lines  sary  to  obtain  accurate  results. 
of  Research      There  will  be  several  trained  field 

workers  connected  with  this  staff 
who  will  visit  the  homes  and  haunts  of  the  con- 
vict in  search  of  facts  throwing  light  on  her 
heredity,  home  and  scholastic  training,  environ- 
ments, and  social  affinities. 

To  this  Research  Department  every  convict 
committed  to  the  Reformatory  is  first  admitted 
and  subjected  to  such  an  exhaustive  study  that 
there  may  be  no  mistake  made  in  determining 
the  kind  of  care  and  treatment  required  to  ef- 
fect her  reform.  When  the  diagnosis  of  her  case 
is  satisfactorily  made  out  she  is  assigned  to  that 
Department  of  the  Reformatory  adapted  to 
apply  the  prescribed  remedial  measures,  or,  if 
necessary,  she  may  be  committed  to  another 


276  WHO   IS   INSANE? 


State  institution  better  equipped  for  her  special 
treatment.  Or,  what  is  of  vastly  greater  im- 
portance, the  study  may  bring  to  light  some 
easily  remedied  defect  in  the  home-life  of  the 
unfortunate  victim  of  circumstances  which  im- 
pelled her  to  a  criminal  act.  With  its  removal 
she  can  return  safely  to  her  home  and  resume 
her  normal  position  in  the  household. 

It  is  apparent  that  in  this  plan  of  operating  a 
Reformatory  for  Women  the  curative  methods 
of  treatment  dictated  by  physiology,  psychology 
and  sociology — the  sciences  which  teach  the  art 
of  healthy  living  and  correct  conduct — will  be 
the  dominant  forces  directing  and  controlling 
the  care  and  treatment  of  the  inmates.  Every 
woman  admitted  will  present  to  the  skilled  and 
expert  Research  staff  a  new  scientific  problem, 
which  must  be  immediately  solved,  that  the  suf- 
ferer may  be  returned  to  her  family  and  to  the 
community  at  the  earliest  possible  moment.  No 
step  will  be  taken  in  her  treatment  until  every 
important  feature  of  her  life-history — heredity, 
diseases,  education,  habits,  social  relations,  men- 
tal peculiarities,  and  present  physical  health — 
have  been  thoroughly  studied  and  recorded. 
From  this  vantage-ground  will  begin  a  course  of 
treatment  having  that  exactness  in  detail  and 
precision  in  application  which  accuracy  in  diag- 
nosis always  secures. 

It  has  already  been  demonstrated  by  the  psy- 


WHO   IS   INSANE?  277 

copathic  hospitals,  where  the  suspected  insane 
are  first  placed  in  observation  buildings  and 
subjected  to  expert  examination  before  admis- 
sion to  an  asylum,  that  large  numbers  are  found 
suffering  from  temporary  ills  which  do  not  re- 
quire for  their  relief  hospital  treatment  nor  cus- 
todial care.  From  a  medical  view-point  there 
can  be  no  doubt  that  if  the  number  of  Bureaux 
of  Social  Science  organized  like  that  at  Bed- 
ford Hills,  was  so  multiplied  that  every  person 
committed  to  public  care  was  subjected  to  an 
exhaustive  examination  by  experts  in  physi- 
olog3%  psychology,  and  sociology,  immediately 
on  admission  to  an  institution,  and  the  course  of 
treatment  indicated  by  the  results  of  such  inves- 
tigation were  rigidly  and  intelligently  enforced, 
our  asylums,  prisons,  reformatories,  and  other 
charitable  and  eleemos^^nary  institutions  would 
in  no  distant  future  be  largely  depopulated,  and 
become  in  a  most  commendable  degree  self-sup- 
porting. Such  a  reform  would  strike  at  the  root 
of  a  vast  number  of  our  social  evils,  restore  to 
communities  a  class  of  hitherto  worthless  or 
dangerous  persons,  and  relieve  the  State  of  a 
source  of  ever-increasing  taxation  which  is  now 
an  intolerable  burden. 

IT  is  painfully  evident  to  an  intelligent  visitor 
to  institutions  for  the  care,  treatment,  or  ed- 
ucation of  those  suffering  from  idiocy,  insanity. 


278  WHO   IS   INSANE? 


epilepsy,  or  other  affections  of  the  nervous  sys- 
tem, that  there  is  too  often  want- 
Enthusiasm  ing,  on  the  part  of  physicians  and 
Is  Needed  care-takers  ahke,  that  genuine 
enthusiasm  in  their  work  which 
insures  the  highest  degree  of  success.  The  vast 
variety  of  symptoms  which  these  diseases  pre- 
sent for  study  attract  but  little  attention,  be- 
cause the  brain  is  a  sealed  book.  All  of  the  in- 
mates are  placed  on  a  dead  level,  and  the  treat- 
ment, instead  of  being  individual,  is  en  masse. 

We  can  only  feebly  conjecture  what  vast  num- 
bers of  feeble-minded  would  be  taught  self- 
care,  what  an  enormous  percentage  of  insane 
would  be  cured,  and  what  universal  reformation 
of  criminals  would  result,  if  every  one  of  these 
classes  now  in  public  care  were  subjected,  indi- 
vidually, to  the  skilled,  patient,  and  persistent 
treatment  of  experts  in  the  physiological  and 
psychological  sciences. 

As  a  conclusion  we  are  profoundly  impressed 
with  the  evidence  that  the  policy  of  the  State  in 
its  care  of  those  persons  who  become  a  public 
charge — insane,  criminals,  idiots,  feeble-minded, 
crippled — should  be  curative,  in  the  sense  of 
enabling  them  to  live  in  a  community  as  moral, 
industrious,  and  self-supporting  citizens.  Abun- 
dant proof  has  been  given  that  untold  numbers 
of  these  life-pensioners  upon  the  taxable  re- 
sources of  the  State,  if  thoroughly  treated  ac- 


WHO   IS   INSANE?  279 

cording  to  the  methods — physiological,  psycho- 
logical, and  sociological — to  be  employed  by  the 
"Bureau  of  Social  Science,"  can  be  rescued  from 
the  asylums,  prisons,  refuges  and  reformatories 
of  the  State.  The  installation  of  that  Bureau, 
as  an  experimental  institution  designed  to  ap- 
pl}^  practically  the  resources  of  science,  art, 
and  humanity  to  rescuing  young  convict  women 
from  lives  of  crime  and  to  demonstrate  thereby 
the  power  of  the  same  method  to  cure  the  de- 
pendent classes  of  their  innumerable  crippling 
ailments,  is  the  dawn  of  a  new  era  in  the  history 
of  Christian  civilization.  For  this  important  ad- 
vance in  practical  philanthropy  too  much  credit 
cannot  be  given  to  Mr.  John  D.  Rockefeller,  Jr., 
and  his  associates,  who  agreed  to  finance  the  un- 
dertaking, and  to  the  Managers  of  the  Bedford 
Reformatory,  who  through  the  good  offices  of 
the  Superintendent,  Dr.  Katherine  B.  Davis,  one 
of  the  most  advanced  students  of  sociology,  fur- 
nished the  detailed  scheme  of  research  and  gen- 
eral administration. 

We  must  add  that  in  this  action  of  the  Bed- 
ford Reformatory  we  recognize  the  inspiration 
of  the  spirit  of  aggressive  reform,  the  indom- 
itable will  in  combating  social  evils,  the  untir- 
ing zeal  in  efforts  to  uplift  the  fallen,  which 
characterized  the  long  and  eventful  life  of  its  il- 
lustrious founder,  Abby  Hopper  Gibbons.  At 
the  age  of  ninety-two  she  visited  the  Committee 
of  the  Legislature  which  had  the  bill  creating 


280  WHO   IS   INSANE? 

the  Reformatory  under  discussion  and  the  sub- 
stance of  her  remarks  was  as  follows:  "A  Re- 
formatory pure  and  simple  is  my  aim.  The 
word  Prison  may  keep  in  the  background. 
Criminals  are  made  what  they  are  by  associa- 
tion and  treatment.  Let  us  turn  over  a  new  leaf 
and  remember  that  they  are  human;  and  that, 
with  tact  and  experience,  it  is  possible  to  'tem- 
per the  wind  to  the  shorn  lamb'  and  soften  the 
heart  of  the  hardest." 


XXIV 

Eugenics 


I 


XXIV 

Eugenics 

lUGENICS  opens  a  field  in  altru- 
ism of  infinite  possibilities  in 
the   prevention    of   public    de- 
pendency.    Galton   says:    "Its 
first  object  is  to  check  the  birth 
rate  of  the  unfit,  instead  of  al- 
lowing them  to  come  into  being, 
though  doomed  in  large  numbers  to  perish  pre- 
maturely; the  second  object  is  the  improvement 
of  the  race  by  furthering  the  pro- 
Objects  of       ductivity  of  the  fit  by  early  mar- 
Eugenics         riages   and  healthful  rearing  of 
their  children."     It  aims  "to  re- 
place natural  selection  by  other  processes  that 
are  more  merciful  and  not  less  effective.    Nat- 
ural selection  rests  upon  excessive  production 
and  wholesale  destruction ;  eugenics  on  bringing 
no  more  individuals  into  the  world  than  can  be 
properly  cared  for  and  those  only  of  the  best 
stock." 

But  Eugenics  is  in  its  experimental  stage.   Its 
method  of  preventing  the  increase  of  the  unfit, 

283 


284  WHO  IS   INSANE? 

by  sterilizing  or  unsexing  those  who  might  be- 
get them,  would  certainly  effect  its  object  if 
rigorously  enforced  by  the  State.  But  the  pro- 
cedure is  naturally  shocking  to  the  moral  sense, 
and  must  be  attended  with  serious  difficulties. 
It  is  a  matter  of  common  observation  that  idiots 
and  feeble-minded  are  sometimes  found  in  the 
homes  of  the  more  intelligent  members  of  a 
community  and  the  best  scholars  in  the  public 
schools  often  come  from  the  homes  of  the  illit- 
erate, who  are  popularly  classed  as  feeble-mind- 
ed. As  idiocy  and  feeble-mindedness  have  not 
been  standardized,  by  what  rule  is  the  public 
officer  appointed  to  sterilize  the  sexes  to  de- 
termine with  absolute  certainty  that  the  subjects 
of  his  operations  would  beget  idiots  or  feeble- 
miinded?  Again,  what  would  be  the  effect  on 
the  morals  of  a  community  in  which  lived  un- 
sexed  feeble-minded? 

So  far  as  the  method  has  been  practiced  un- 
der rules  and  regulations  established  by  the 
State,  the  reported  results  are  not  conclusive  as 
to  the  propriety  of  its  general  adoption  and 
rigid  enforcement.  It  is  certain  that  whenever 
the  method  is  legalized  it  should  be  protected 
with  such  safeguards  as  will  effectually  prevent 
abuses. 

It  may  well  be  questioned,  whether  the  more 
rational  methods  of  improving  the  race  should 
not  now  be  in  accord  with  the  second  object  of 


WHO   IS   INSANE?  285 

Eugenics,  as  stated  by  Galton,  viz.,  "by  further- 
ing the  productivity  of  the  fit  by  early  mar- 
riages and  healthy  rearing  of  children."  To  this 
should  be  added  restriction  of  marriage  of  the 
unfit,  segregation  of  the  sexes  most  exposed  and 
unprotected,  and  such  education  as  will  enable 
them  to  practice  self-care  and  self-support. 


T 


HE    following   pages   contain    advertisements   of 
books  by  the  same  author  or  on  kindred  subjects 


TWO  IMPORTANT  BOOKS  BY 

HENRY  H.   GODDARD 

Director  of  the  Research  Laboratory  of  the  Training  School  at  Vineland,  NJ^ 
for  Feeble-Minded  Girls  and  Boys 

FeeDle-Mindeaness  :    Its  Causes  and  Consequences 

Cloth,  8vo,  SQQ  pages,  $4.00 

It  differs  from  most  of  those  in  the  field  in  that  it  is  what  may  be 
termed  a  source  study.  Instead  of  generahzing  on  the  subject  of  feeble- 
mindedness, presenting  arguments  for  this  theory  and  that,  and  con- 
cluding with  vague  speculations,  Dr.  Goddard  gives  facts.  The  book 
is  so  comprehensive  in  scope  and  the  cases  exhibit  such  a  variety  of 
disorders  that  not  infrequently  will  the  parent,  the  teacher,  and  all  who 
have  to  do  with  incorrigible,  delinquent,  or  unfortunate  children  en- 
counter characteristics'  similar  to  those  displayed  by  the  subjects  dis- 
cussed by  Dr.  Goddard.  This  work,  therefore,  contains  a  thorough 
consideration  of  this  vital  subject  which  was  so  interestingly  presented, 
in  the  case  of  a  single  family,  in  the  author's  former  book,  "  The  Kalli- 
kak  Family." 

The  Kallikak  Family 

A  STUDY  m  THE  HEREDITY  OF  FEEBLE-MINDEDNESS 

Cloth,  8vo,  $1.^0 

"  No  more  striking  example  of  the  supreme  force  of  heredity  could 
be  desired."  —  The  Dial. 

"  The  most  illuminating  and  complete  of  all  the  studies  in  heredity 
that  have  ever  been  made,  with  the  view  of  showing  the  descent  of 
mental  deficiency."  —  Bulletin  of  the  Medical  and  Chirtirgical  Faculty 
of  Maryland. 

"  This  is  the  most  convincing  of  the  sociological  studies  brought  out 
by  the  eugenics  movement." —  The  Indepetident. 

"The  book  is  an  exceedingly  important  monograph  and  will  be  of 
interest  to  all  students  of  heredity  and  eugenics  as  well  as  to  social 
workers  and  reformers."  —  Social  Diseases. 

"Dr.  Goddard  has  made  a  ^find' ;  and  he  has  also  had  the  training 
which  enables  him  to  utilize  his  discovery  to  the  utmost."  —  American 
Journal  of  Psychology. 

THE   MACMILLAN  COMPANY 

Fnblishers  64-66  Fifth  Avenue  New  York 


Psychology  :  Normal  and  Morbid 

By  CHARLES  A.  MERCIER 

ji8  pages y  8vo,  $4.00 

The  normal  psychological  processes  are  dealt  with  from  the  point  of 
view  and  for  the  purposes  of  the  alienist.  The  subjects  taken  up  are : 
Sensation,  Belief,  Volition,  Memory,  Pleasure  and  Pain,  Subject-Con- 
sciousness, and  Logic,  not  the  so-called  Formal  Logic,  but  the  Science 
of  Reasoning  Processes  generally. 

A  Text-Book  of  Insanity 

By  CHARLES  MERCIER 

222  pages,  i2mo,  $2.2^ 

By  describing  the  various  forms  of  insanity  as  types,  and  avoiding 
that  great  mass  of  illustrative  material  which  in  most  cases  gives  such 
bulk  to  text-books,  the  author  has  given  a  concise  treatment  of  insanity, 
its  causes  and  varieties,  which  is  valuable  to  the  student  of  mental 
pathology. 

The  Unconscious 

The  Fundamentals  of  Human  Personality,  Normal  and  Abnormal 
By  MORTON   PRINCE,  M.D.,  LL.D. 

^4g  pages,  i2mo,  $2.00 

An  introduction  to  abnormal  psychology.  The  problems  considered, 
however,  belong  equally  to  normal  psychology  in  that  they  are  problems 
of  psycho-physiological  functions  and  mechanisms. 


THE    MACMILLAN    COMPANY 

Publishers  64-66  Fifth  Avenue  New  York 


The  Problem  of  Knowledge 

By  DOUGLAS   CLYDE   MACINTOSH,  Ph.D. 

Assistant  Professor  of  Systematic  Theology  in  Yale  University 

Cloth^  8vo,  $2.^0 

For  more  than  a  century  the  problem  of  knowledge  has  been  the 
cockpit  of  philosophers.  A  large  part  of  this  work,  which  is  mainly 
occupied  with  the  problem  of  acquaintance,  the  problem  of  truth,  and 
the  problem  of  the  scientific  method  of  proof,  is  devoted  to  an  exposition 
and  critique  of  recent  and  contemporary  doctrines.  Many  of  the  most 
interesting  and  important  of  these  have  not  yet  found  their  way  into  the 
histories  of  philosophy,  and  some  have  been,  up  to  the  present,  practi- 
cally inaccessible  to  English  readers.  Three  of  the  twenty  chapters  are 
given  to  dualism  and  agnosticism,  five  to  idealism,  and  four  to  the  new 
realism.     Intellectualism  and  pragmatism  also  receive  detailed  attention. 

The  Executive  and  His  Control  of  Men 

A  Study  in  Personal  Efficiency 

By  ENOCH  BURTON  GOWIN 

Of  the  New  York  University  School  of  Commerce 

C/o^^,  i2mo,  $1.^0 

The  author's  primary  aim  in  this  book  is  to  increase  one's  executive 
ability.  Accordingly  he  tells  how  personal  efficiency  is  developed, 
treating  such  topics  as  The  Energizing  Rate,  The  Increase  of  Power, 
Organization,  and  Systematic  Personal  Effort.  The  various  methods 
by  means  of  which  the  executive  motivates  his  men  are  then  considered, 
in  which  connection  is  discussed  the  role  of  personality,  suggestion, 
emulation,  rewards,  instruction,  etc.  The  third  part  of  the  book  an- 
alyzes the  limits  upon  the  executive's  power,  such  as  apathy,  opposition 
and  competition,  and  shows  how  these  may  be  dealt  with.  The  book 
treats  an  important  subject  in  a  practical  way ;  it  makes  use  of  the  best 
things  in  modern  social  psychology  and  applies  it  directly  to  the  execu- 
tive. It  should,  therefore,  be  of  interest  to  students  of  social  psychology 
as  well  as  of  business  and  to  executives. 


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The  Great  Society 

A  Psychological  Analysis 
By  graham  wallas 


Author  of  "  Human  Nature  in  Politics  " 


Cloth,  8vo,  $2.00 


Graham  Wallas's  new  book,  "The  Great  Society,"  will  be  equally 
interesting  to  the  psychologists,  students  of  sociology,  politics  and  the 
general  reader.  Mr.  Wallas  is  a  man  of  wide  connections  in  England, 
a  man  whose  experience  has  well  fitted  him  for  the  task  which  he  has 
essayed.  He  has  been  for  many  years  a  university  extension  lecturer; 
he  was  at  one  time  a  member  of  the  school-board  of  London,  chairman 
of  the  School  Management  Committee,  a  member  of  the  Technical 
Education  Board,  of  the  London  County  Council  and  of  the  Education 
Committee  of  that  council.  He  has  been,  since  1896,  a  lecturer  at  the 
London  School  of  Economics.  He  has  served  on  the  Senate  of  London 
University,  as  university  reader  in  political  science  and  on  the  Royal 
Commission  on  Civil  Service.  He  has  written  more  or  less  widely,  his 
most  popular  publication  being,  perhaps,  "  Human  Nature  in  Politics." 

The  present  work,  a  portion  of  which  was  delivered  last  winter  as  the 
Lowell  Lecture  in  Boston,  begins  with  an  exposition  of  what  the  author 
means  by  the  term  "  The  Great  Society."  It  then  proceeds  to  a  con- 
sideration of  the  following  topics :  Disposition,  Social  Psychology, 
Instinct  and  Intelligence,  Disposition  and  Environment,  Habit,  Fear, 
Pleasure,  Pain,  Happiness,  The  Psychology  of  the  Crowd,  Love  and 
Hatred,  Thought,  The  Organization  of  Thought,  The  Organization  of 
Will,  and  the  Organization  of  Happiness. 

"  His  deft  and  almost  subtle  grasp  of  the  viewpoints  of  the  philo- 
sophic factors  in  history ;  his  focusing  of  a  theory  into  the  tiny  sun- 
spot  of  an  illuminant  sentence,  and  adopting  a  style  that  is  as  inviting 
and  penetrating  as  Havelock  Ellis,  make  the  book  one  of  sustained 
interest."  —  Galveston  Daily  News. 


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